HospitalInspections.org

Based on record review and interview, it was determined that the facility failed to provide patients sufficient notice regarding advance directives.

Findings include:

Interview with Staff B, (CNO) on 2/19/16 revealed that the same admission packet is given to admissions to the Acute Care facility, and also to direct admissions to a swing bed. Review of the facility's admission packet revealed that it includes the "Foundation for Healthy Communities Advance Care Planning Guide", and an "Advanced Medical Directive Acknowledgement Form". There is; however, no notice that individuals may file complaints concerning advance directive requirements with the state's survey and certification agency.

Based on observation and interview, the CAH failed to ensure that all equipment is maintained in safe operating condition.

Findings include:
Observation during tour on 2/18/16 at 9:10 a.m. in the "Dirty Lab" of Internal Medicine revealed a microscope (#001021) with no inspection sticker and a centrifuge (#001019) that had been inspected in August 2010 and was due for inspection in August 2011.

Interview with Staff B (Chief Nursing Officer) confirmed that the equipment had not been inspected and revealed that the hospital biomedical department was unaware that the equipment was located in the practice.

Based on observation and interview, the CAH failed to ensure that biologicals were appropriately stored in 1 of 3 rooms located in specialty services.

Findings include:
Observation during tour of speciality services on 2/18/16 at 8:15 a.m. revealed that the lock was broken on the cupboard that contained needles in the exam room used by the pain clinic.

Interview with Staff C (Nurse Manager) confirmed the above finding.

Based on observation and interview, the CAH failed to provide safe care practices for INR testing and a sanitary environment for the ice scoop in the kitchen.

Findings include:
Interview with Staff E (Register Nurse) on 2/18/16 at 8:25 a.m. revealed that the Coaguchek XS used for INR testing on coumadin patients was cleaned once daily, not between patients.

Interview with Staff B (Chief Nurse Officer) on 2/19/16 at 9:20 a.m. revealed the coumadin clinic performed INR testing on 15-20 patients a day, 4 days a week using the Coaguchek XS.

During tour of the kitchen on 2/17/16 at 9:45 a.m., the ice scoop was in a vertical scoop holder and was touching the bottom. The bottom of the holder was moist and discolored brown.

Based on observation and interview, the CAH failed to meet the laboratory requirements specified in Part 493 of this chapter for testing urine sediment and glucose testing.

Findings include:

Observation of the centrifuge in the "Dirty Lab" of internal medicine revealed that it was a single speed centrifuge. On the date of the last tachometer reading in August 2010, the centrifuge was recorded to spin at 6687 RPM. This speed is not an accepted standard of practice for spinning urine sediments.

Interview with Staff D (Physicians Assistant) on 2/18/16 at 9:30 a.m. revealed that Staff D uses the centrifuge to spin urine for performing urine sediments.

Interview with Staff B (Chief Nurse Officer) on 2/19/16 at 9:10 a.m. revealed that the CAH does not have a procedure for performing point of care urine sediments. The medical group performed 108 urine sediments in 2015.


31937

Findings include:

During tour of the Emergency Department it was observed in the 4 bed trauma room that RBG (Random Blood Glucose) test strips were not dated when opened and the high and low control solutions were dated with an expiration date of "12/14/15".

Interview on 2/18/16 with Staff J (RN/Emergency Room Director) who confirmed the test strips should have been dated with either the expiration date or the open date. The high and low control solutions were out dated.

Based on record review and interview, it was determined that the facility failed to ensure that medical records were accurately written and/or complete for 3 patients in a survey sample of 71 patients. (Patient identifiers are #9, #16, and #29.)

Findings include:

Patient #16
Record review revealed the patient was moved from acute bed status to swing bed status on 2/17/16. Review of physician orders for the period 12/11/15 - 12/16/15 revealed that the order for this move was written as "SNF (SWING LEVEL CARE)" with no distinct order to discharge the patient from the Acute Hospital stay.

Patient #29
Record review revealed the patient was moved from acute bed status to swing bed status on 2/11/16. Review of physician orders for the period 12/11/15 - 12/16/15 revealed that the order for this move was written as "SNF" with no distinct order to discharge the patient from the Acute Hospital stay.

Patient #9
Review of this patient's record revealed the patient was admitted to a SNF/swing bed on 2/11/16 from an Acute Care stay at this facility. While there was an order for admission to SNF dated 2/11/16, there was no physician order for discharge from the Acute Care facility.

Review of this patient's "History and Physical Examination" for this patients dated 2/11/16 revealed that, "The patient presented to the emergency room on 02/08/2016." Interview with Patient #9 on 2/18/16 revealed that on 2/8/16 that Patient #9 went directly to the Operating room and was being discharged today (2/18/16). Interview with Staff G, (RN) and Staff H, (Coordinator) confirmed that Patient #9 did not go to the emergency Room on 2/8/16.

Review of this patient's signed consent for Treatment Authorization, revealed that the patient signed a receipt for the Patient Bill of Rights and Policy on Living Will on 2/12/16. Interview with Staff F (Vice President), on 2/19/16 revealed that sometimes this form doesn't get signed until the next day after admission.

Review of this patient's "An Important Message From Medicare About Your Rights" notice revealed it was signed by the patient/patient representative on 2/15/16, 4 days after admission and 3 days prior to anticipated discharge, therefore, not in a timely manner. Per interview with Staff I on 2/18/16, this form is due within 48 hours of admission to Acute and Swing, and 48 hours before discharge.



















16285

Based on record review and interview it was determined that the hospital failed to properly execute informed consent for treatment at the critical access hospital for 3 Patients in a survey sample of 71 Patients. (Patient identifiers are #19, #31, and #34).

Findings include:

Review of the hospital policy and procedure titled "Consent" dated "October 22, 2015" revealed in the section labeled "...General: ...Each patient's medical record must contain evidence of the patient's or his/her legal representative's consent for treatment during hospitalization..."

Patient #19
Record review of Patient #19's medical record from the Medical Surgical/Swing Unit revealed an incomplete consent which did not include the reason why Patient #19 or the DPOA (Durable Power of Attorney) did not sign the consent to treat form on 2/17/16.

Interview on 2/18/16 with Staff B (Chief Nursing Officer), after Staff B reviewed the above patient records from the Medical Surgical/Swing Unit, confirmed that the patient consent to treat form was incomplete.


16285


Patient #33
Review of this patient's record reveals they expired on 1/15/16 at 0915, and the Death Documentation Record records that Organ Bank was called on 1/15/16 at 1120. This interval exceeds the form's instruction "Must call within 60 minutes of asystole: ...." The Organ Bank identified the patient as a Potential Donor, and the form documents (patient) "released @ 1535"; however, does not inform if the Organ Bank authorized the release and will be involved in the disposition of the body. A Progress Notes Report for 1/15/16 at 1416 does relate "... call received from [organ bank] to release per family." Interview with Staff F, (Vice President), on 2/19/16 revealed that the Organ Bank called back, indicated the family does not want to donate, so okayed release of the body to the funeral home.


Patient #34
Review of Case Mix Detail Patient - Inpatient documentation reveals Patient #34 was discharged on 2/7/16 with a Principal Diagnosis of Left Ventricular Failure. Review of the patient's Discharge Summary Note of 2/7/16 reveals a Discharge Condition of Expired, and a list for Discharge Diagnosis that includes Pulmonary Edema and Pneumonia, but no cardiac diagnosis to correspond with the Principal Diagnosis above.


31937

Patient #18

Review of Patient #18's medical record from physician's medical office revealed a Consent For Treatment that had expired on 3/31/15. A new Consent For Treatment had been obtained on 12/21/15, however the patient received services on 12/14/15 and there was not an active Consent For Treatment to cover this visit.

Interview on 2/18/16 with Staff G (RN) , Staff G confirmed the Hospital did not have a valid Consent For Treatment form.

Patient #46

Review of Patient #46's medical record from physician's medical office revealed a Consent For Treatment that had expired on 12/6/13. A new Consent For Treatment had not been obtained as of 2/19/16 and the patient received services on 12/17/15. There was not an active Consent For Treatment to cover this visit.

Interview on 2/18/16 with Staff G (RN) , Staff G confirmed the Hospital did not have a valid Consent For Treatment form.

Patient #47

Review of Patient #47's medical record from physician's medical office revealed a Consent For Treatment that had expired on 10/1/14. A new Consent For Treatment had been obtained on 2/16/16, however the patient received services on 12/14/15 and there was not an active Consent For Treatment to cover this visit.

Interview on 2/18/16 with Staff G (RN) , Staff G confirmed the Hospital did not have a valid Consent For Treatment form.

Based on record review and interview the facility failed to maintain complete closed medical records.

Findings include:

Review of the deficiency report dated 2/18/16 indicated that a total of 4321 medical records were delinquent over 30 days and needed physician signatures. Thirty records were missing text and 168 records were missing dictation. There were a total 3,207 records that were delinquent greater than 120 days with some records dating back to 2008.

Interview on 2/18/16 with Staff A (VP Risk Management/Medical Records) confirmed the above findings.

Based on record review and interview, it was determined that the facility failed to ensure that one of two sampled swing bed residents was provided an ongoing program of activities designed to meet their assessed needs. (Patient identifier is #8.)

Findings include:

Patient #8

Review of this patient's record revealed they were admitted directly to a SNF/swing bed on 1/28/16, and interview with the patient on 2/18/16 revealed that the patient hopes to go home on Saturday. Further review of record revealed that the Patient Care Plan Report has a plan to Provide/Alternate Activities to Prevent Boredom, but there is no assessment of the patient's activity related interests and no consult with the Activity person utilized by the facility.

Interview with Staff F, (Vice President) on 2/19/16 revealed that there was no assessment of Patient #8's interests and no documentation of any activities offered.