HospitalInspections.org

Based on observation and staff interview the Critical Access Hospital (CAH) failed to ensure that toxic chemical cleaning solutions were stored in a safe manner and failed to ensure that patient care areas were maintained to prevent potential accidents.

Findings include: The CAH failed to store cleaning solutions in locked cabinets in birthing rooms 101 and 102. These rooms were located down the hallway from the main nursing station.

During the environmental tour at 12:30 p.m. on 6/25/10, it was observed that six spray aerosol cans of Lysol Foam Cleaner were located under the sink counter in birthing room 101, and four spray aerosol cans of Lysol Foam Cleaner were stored under the sink counter in birthing room 102. The cupboard doors under the sink were unlocked and the sink was located adjacent to the birthing beds. The doors to the room were unlocked and the Lysol Foam Cleaners were readily accessible for use. The MSDS (Material Safety Data Sheet) information indicated: "Caution: May cause eye irritation. Avoid contact with eyes or skin. Keep out of the reach of children".

The Associate Administrator was interviewed at 10:30 a.m. on 6/29/10 and confirmed that these toxics should have been stored more securely.

Based on record review and staff interview, the critical access hospital (CAH) failed to ensure that each medical entry was properly authenticated by the certified registered nurse anesthetist (CRNA) with a timed and dated signature for 11 of 13 surgical records reviewed, (S1, S2, S3, S4, S5, S6, S7, S30, S31, S32, and S33); and by the surgeon for 7 of 11 surgical records reviewed (S2, S3, S4, S5, S30, S31, and S34.)

Findings include: Eleven surgical records (S1, S2, S3, S4, S5, S6, S7, S30, S31, S32, and S33) reviewed lacked proper authentication of entries into the medical record including dated and timed signatures by the CRNA. Examples include: All eleven surgical records reviewed lacked dated and timed signature authentication by the CRNA on the post aneshesia evaluation. Records include: S1 admitted on 4/15/10 for a cesarean section; S2 admitted on 3/9/10 for a shoulder arthroplasty; S3 admitted on 3/24/10 for right hemicolectomy/nephrectomy; S4 admitted on 2/22/10 for total abdominal hysterectomy; S5 admitted on 3/28/10 for exploratory laparotomy/right hemicolectomy; S6 admitted on 4/16/10 for Cesarean Section; S7 admitted 6/16/10 for carpal tunnel release; S30 admitted 5/12/10 for an hemorrhoidectomy; S31 admitted 5/14/10 for a laparoscopic cholecystectomy; S32 admitted 5/19/10 for cataract removal; and S33 admitted 4/8/10 for bilateral myringotomy with tube placement.

Seven surgical records (S2, S3, S4, S5, S30, S31, and S34) lacked dated and timed signatures by the surgeon on the Operative Reports. Records include: S2 admitted on 3/9/10 for a shoulder arthroplasty; S3 admitted on 3/24/10 for right hemicolectomy and nephrectomy; S4 admitted on 2/22/10 for total abdominal hysterectomy; S5 admitted on 3/28/10 for exploratory laparotomy/right hemicolectomy; S30 admitted 5/12/10 for an hemorrhoidectomy; S31 admitted 5/14/10 for a laparoscopic cholecystectomy; and S34 admitted 5/7/10 for a breast excision.

Interview with the Associate Administrator at 10:30 a.m. on 6/29/10 confirmed there had been identified concerns with proper authentication including times and dates for entries made into the medical record.

Based on staff interview and record review, the Critical Access Hospital (CAH) failed to ensure that a proper anesthesia recovery evaluation had been conducted by a qualified practitioner prior to discharge from the CAH for 11 of 13 surgical records reviewed (S1, S2, S3, S4, S5, S6, S7, S30, S31, S32, and S33).

Findings include: The certified registered nurse anesthetist (CRNA) did not provide documentation of a thorough post anesthesia evaluation for 11 surgical patients whose records were reviewed.

The CRNA documented post anesthesia notes lacked assessment of the cardiopulmonary status of patients following recovery from anesthesia in the following patient records: S1 admitted on 4/15/10 for a cesarean section; S2 admitted on 3/9/10 for a shoulder arthroplasty; S3 admitted on 3/24/10 for right hemicolectomy/nephrectomy; S4 admitted on 2/22/10 for total abdominal hysterectomy; S5 admitted on 3/28/10 for exploratory laparotomy/right hemicolectomy; S6 admitted on 4/16/10 for Cesarean Section; S7 admitted 6/16/10 for carpal tunnel release; S30 admitted 5/12/10 for an hemorrhoidectomy; S31 admitted 5/14/10 for a laparoscopic cholecystectomy; S32 admitted 5/19/10 for cataract removal; and S33 admitted 4/8/10 for bilateral myringotomy with tube placement.

Review of the Anesthesia Records for each of these 11 patient records revealed the Post Anesthesia Comment had been documented by the CRNA as, "did well." No further documentation was evident to indicate an assessment of the patient's cardiopulmonary status had been conducted.

Interview with the Associate Administrator at 10:30 a.m. on 6/29/10, confirmed docoumentation of a thorough post anesthesia evaluation by the CRNA was lacking.

Based on record review and staff interview, the Critical Access Hospital (CAH) failed to document in 3 of 5 outpatient surgical records (S30, S32 and S34) reviewed that the surgical patient had been discharged in the company of a responsible adult.

Findings include: Documentation was lacking in outpatient surgical records S30, S32 and S34 to indicate the patient had been discharged in the company of a responsible adult.

It was noted during record review that S30 had a hemorrhoidectomy on 5/12/10 and documentation was lacking to indicate that she had been discharged with a responsible adult. Patient record S34 indicated the patient had local anesthesia with sedation for the excision of a left breat mass on 5/7/10. Documentation was lacking to indicate the patient had been discharged with a responsible adult. It was also noted in surgical outpatient record S32 that the section related to disharge in the care notes "discharge to home with____", had been left blank. The patient had cataract surgery on 5/19/10.

Upon interview with the Surgical Services Coordinator at 11:00 a.m. on 6/29/10, it was verified there had been a problem with staff failure to document who had accompanied patients upon discharge after outpatient surgical procedures.