HospitalInspections.org

Based on policy and procedure review, medical record review, PAL (patient advocate) report review, grievance committee meetings review, personnel file and job description review and staff interviews nursing staff failed to provide supervision of care resulting in a certified nursing assistant one (CNA I) practicing outside their scope of practice and performed Ostomy care in 1 of 2 patient charts reviewed (Patient #11).

The findings include:

Review of the policy and procedure titled "Ostomy Care" effective date 05/2017 revealed "PURPOSE/POLICY-An ostomy appliance provides an external pouch for collection of stool or urine through a stoma opening at the skin level. The information provided in this policy serves to ensure maximum skin protection and prevention of skin breakdown...QUALIFICATIONS RN (registered nurse) ..."

Review of a closed medical record revealed Patient #11 was admitted on 04/16/2020 for Sepsis (blood stream infection) due to a UTI (urinary tract infection) and Acute metabolic encephalopathy (damage or disease that affects the brain). Patient #11 had a history of quadriplegia (paralysis of all four limbs), Colectomy (surgical procedure to remove all or part of the colon) and Ostomy on 02/26/2020. Review of the Ostomy "site assessment" and "Peri-wound Assessment" from 04/16/2020 at 1429 through 04/20/2020 at 0830 revealed staff documented "UTA (unable to assess);Clean; Intact." Review of the Ostomy "site assessment" and "Peri-wound Assessment" (WOC #1-wound ostomy nurse) dated 04/21/2020 at 1552 revealed "Large Wound next to ostomy pouch causing BID (twice a day) pouch chgs (changes)." Review revealed Patient #11 was discharged on 04/21/2020.

Review of the PAL report dated 04/29/2020 at 1706 revealed the response from the Nurse Manager (NM #1) "The NA (CNA #1) did change the Ostomy bag, it is in NA scope. She replaced with the same size appliance that was in place prior..."

Review of the grievance committee meeting minutes dated 06/03/2020 at 1115-1140 revealed "PAL #1 stated that WOC #1 pulled the policy and that CNAs (CNA I) aren't to change ostomy bags..."

Review on 10/30/2020 of CNA #1's personnel file failed to reveal she received training to perform Ostomy care. Review of CNA #1's job description failed to reveal qualifications to perform Ostomy care. Review of the CNA #1's nurse aide certification revealed an expiration date of 06/30/2021.

Interview requested with CNA #1 on 10/27/2020 revealed she was no longer employed with the hospital.

Based on procedure review and observation during tour, facility staff failed to follow eye covering personal protective equipment (PPE) procedures in 5 of 17 patient care units.

Review of facility procedure titled "Eye Covering PPE for (Named Facility) Employees" undated, revealed, "...Eye coverings have been added to PPE for (Named Facility) employees in patient care areas, regardless of the patient's COVID (Coronavirus) status. The importance of using personal protective equipment ... and following safety guidelines ... are vital for preventing asymptomatic transmission. Masks and eye protection should be worn by employee [sic] when providing patient care or when visiting a room where a patient is present. When providing patient care or entering a patient's room, the employee is required to wear eye protection in the form of: - Goggles..."

Observation was conducted during tour of the facility's Medical Intensive Care Unit (MICU) on 10/29/2020 at 1000. In room 54, 2 staff members were observed providing patient care. 1 staff member had no goggles on, and the other had their goggles on top of their head. In room 41, 2 staff members were observed providing patient care without goggles. In room 50, 1 staff member was observed providing patient care with their goggles on their forehead.

Observation during tour of the Emergency Department was conducted on 10/29/2020 at 1032. In room 48, a Nurse was observed assessing a patient without goggles.

Observation was conducted during tour of the facility's Cardiac Care Unit (CCU) on 10/29/2020 at 1020. In room 22, 1 staff member was observed providing patient care with their goggles on their forehead. In room 20, 1 staff member was observed providing patient care with their goggles on their forehead. In room 17, 3 staff members were observed providing patient care with no goggles on.

Observation during tour of the 5 North Unit was conducted on 10/29/2020 at 1400. In room 515, a Nurse Practitioner was observed assessing a patient without goggles.

Observation on 10/28/2020 at 1600 during unit tour revealed RN (Registered Nurse) #1 removed medication from the pyxis and entered patient room #435 with a mask covering her nose and mouth. Observation revealed RN #1 exited the patient room after administering the medication with the same mask in place covering her nose and mouth. Observation revealed RN #1 did not have protective eye wear (goggles or glasses) on upon entering or exiting the patient room. Observation at 1628 revealed NA (Nursing Assistant) #2 entered patient room #407 with a mask covering her nose and mouth. Observation revealed NA #2 did not have protective eye wear on upon entering. Observation revealed NA #2 was assisting the patient with care.

Interview on 10/28/2020 at 1620 with RN #1 revealed her protective eye wear (goggles/glasses) were in her locker. Interview revealed RN #1 "didn't recon she had them (goggles/glasses) on" while in the patient room.

Interview on 10/28/2020 at 1628 with RN #3 the Interim Nurse Manager revealed the expectation was for the staff to wear face mask and protective eye wear (goggles/glasses) while in the patient room. Interview confirmed RN #1 and NA #2 did not have on eye wear when they entered the patient rooms.

Interview conducted with the MICU Manager on 10/29/2020 at 1000 revealed staff are expected to wear goggles when performing patient care.

Interview on 10/29/2020 at 1032 with the nurse providing care for the patient in room 48 revealed she was supposed to wear goggles while in a patients room, however "I must have left them at the nurses station."

Interview was not conducted with any staff on the CCU due to a patient's condition deteriorating.

Interview conducted with the 5 North Unit Manager on 10/29/2020 at 1400 revealed staff and providers are expected to wear goggles when performing patient care and assessments.

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