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Based on observation, interview, and record review the facility failed to ensure that a patient's right to privacy was maintained during medication administration.

The Findings:

During the initial tour of the facility, it was observed that a nurse was standing by the bedside of the patient in A bed of room 5114, administering an orange colored liquid in a 60 cubic centimeter (cc) syringe attached to a tube leading into the patient's stomach. This was visible from the hallway. The door was not closed and the privacy curtain was not drawn.

Interview with the nurse on 8/13/10 at 11:05 AM, revealed that she thought that her body would block what she was doing from anyone's view. She admitted she should have pulled the curtain and closed the door.

Review of the facility's policies and procedures revealed that the standard of practice was to close the door and pull the curtain.

Based on observation and interview the facility failed that nursing services were provided to one patient (#1) of 20, in order to meet the needs for repositioning as ordered by the patient's Physician.

The Finding Include:

Review of patient #1's record revealed that the patient had a pressure ulcer on the coccyx. Further review revealed an open area with a red base was present on admission to the facility, but the pressure ulcer is now at stage IV with the application of a debriding agent (Santyl). According to patient #1's record, preventive measure were put into place which included turning and repositioning.

Interview with patient #1's friend on 8/13/10, revealed that they had repeatedly complained to the staff about not turning patient #1 according to the physician's orders. The friend also indicated that the patient had an unstageable pressure ulcer on the coccyx.

Observation of this patient began at 11 AM on 8/13/10. The patient was laying supine in the bed with the spouse at the bedside.
At 12 noon the patient was observed lying supine in the same position with the spouse reading in the chair.
At 1 PM, the patient was observed lying supine in the same position with the spouse near.
At 3 PM, the patient was observed turned to the left side.

Interview with patient #1's spouse on 8/13/10 at PM, revealed that the nurse had come in and turned the patient at approximately 2:30 PM.

Review of the physician's orders revealed that he/she had written and order on 8/9/10 "Aggressive turning [every] 2 Hours". This order was documented in the nursing plan of care.

Review of the nursing documentation for 8/13/10, revealed a nursing note that stated:
***AGGRESSIVE TURNING [every] 2 H**********8/13/10 12:00: to left side**** signed electronically by a Registered Nurse (RN). Patient #1 was on a 3 point turning program according to nursing documentation.

Administration had nothing to state when they were approached with the above information on 8/13/10. Administration stated that they would take care of it.

Review of the facility's policy revealed that when a turning program is initiated, it is a 3 point turning program it is left side first, right side second, supine third and chair if appropriate last.

Review of the facility policy revealed that when a turning program is initiated, it is a 3 point turning program it is left side first, right side second, supine third and chair if appropriate last. Patient #1 was on a 3 point turning program according to nursing documentation.

Based on observation, interview and record review, the facility failed to ensure that they followed the facility's policies and procedures for medication administerion.

Findings:


During the initial tour of the facility, it was observed that a nurse was standing by the bedside of the patient in A bed of room 5114, administering an orange colored liquid in a 60 cubic centimeter (cc) syringe attached to a tube leading into the patient's stomach. This was visible from the hallway. The door was not closed and the privacy curtain was not drawn.

Interview with the nurse on 8/13/10 at 11:05 AM, revealed that she thought that her body would block what she was doing from anyone's view. She admitted she should have pulled the curtain and closed the door.

Review of the facility's policies and procedures revealed that the standard of practice was to close the door and pull the curtain.

Based on observation and interview the facility failed to ensure that they maintained an Infection control log for the facility, according to their own policies and procedures.

The Findings Include:

Review of the Infection Control listing for the hospital did not include any patients except the ones currently in-house.

Interview with the Infection Control Nurse on 8/13/10 at 10:00 AM, revealed that she does not keep a log except for a form on the computer which tracks in house patients. When asked about discharged patients and how she keeps a tally for the total for the month, she indicated that only the in-house patients got tracked and trended and reported to the Quality Assurance Performance Improvement (QAPI) Committee monthly.

Review of the facility's policy manual for the facility did not reveal any Infection Control Log for tracking all patients.