HospitalInspections.org

Based on medical record review, policy review and staff interview, it was determined that the registered nurse (RN) failed to supervise and evaluate the nursing care for 2 of 4 patients (Patient #'s 1 and 3) in the sample. Findings included:

The hospital policy entitled "Right to Informed Consent" stated, "...A medication consent form is completed...when new medications are ordered...consents for a dependent patient or minor are valid only when witnessed and documented by two staff in the medical record..."

The hospital policy entitled "Inpatient Precautions" stated, "...Safety Risks...FP (Fall Precautions)...is indicated if the patient is identified as a fall risk. Fall interventions are identified on the Treatment Plan..."

The hospital policy entitled "Care of the Patient Fall Prevention Program Fall Assessment, Alert and Intervention (Fall Precautions)" stated, "...hospital facilitates patient safety through the identification of patients at risk of injury due to falls...fall precaution options are utilized...initiate 'Fall Precautions'..."

Medical record review revealed:

A. Patient #1 (16 year old)

1. The "Medical Consent" form contained documentation that the "mother gave permission" or "mother gave consent" for the following medications; however, there was no evidence the consent was witnessed and documented by two staff:

8/11/17 - Zyprexa
8/17/17 - Ativan
8/18/17 - Artane

These findings were confirmed by Director of Nursing A on 8/31/17 at 3:32 PM.

B. Patient #3

1. "Incident Report Form" documented:
- had 2 observed falls which occurred on 7/3 and 7/15/17
- was on fall precautions at the time of the fall on 7/3/17

2. "Fall Risk Assessment Tool" assessments dated 6/30, 7/3 and 7/5/17 documented that Patient #3 was a "Moderate Risk" for falls

3. Care plan was revised on:
a. 7/3/17
- added Fall Precautions and interventions

b. 7/15/17
- added interventions including comfort rounds (toileting, rest, fluid/food, any needs)

4. "Nursing Note Post Patient Fall", dated 7/3/17, documented, "Move patient to a room near the nurse's station"

5. No evidence to support that:
- the patient's room assignment was moved closer to the nurse's station on or after 7/3/17
- fall precautions were implemented on any date from 7/4 - 7/24/17

These findings were confirmed by Director of Nursing A on 8/31/17 between 3:42 PM and 3:54 PM.

Based on observation, policy review and staff interview, it was determined that for 93 of 93 inpatients on 8/30/17, the hospital failed to ensure that patient accessible facility areas were maintained for safety. Findings included:

The hospital policy entitled "Environmental Services" stated, "...It is the policy...to promote a sanitary environment..."

The hospital policy entitled "Maintenance Work Request System" stated, "...maintenance...those actions required to restore equipment, building...to normal conditions...should be performed at the first opportunity..."

During an environmental tour with Nurse Coordinator C on 8/30/17 between 9:50 AM and 11:10 AM, the following observations were made and acknowledged/confirmed at the time of discovery:

A. 9:52 AM: Bathroom #8
- a cloth upholstered chair with a small used/soiled cloth towel covering the back portion of the seat cushion

B. 10:30 AM: Unit D East Patient Community Room Bathroom
- drywall over sink was soiled, stained (approximately 2 feet x 18 inches) with various shades of tan and brown
- approximately 13 inches x 6 inches of drywall above the sink was pulled away exposing the under netting
- electrical outlet had no cover

C. 10:38 AM: Bathroom in Room #26
- the bottom of the curtain at the entrance of the bathroom spilled onto the floor presenting a tripping hazard

D. 10:50 AM: Bathroom #33
- an area (approximately 2.5 feet x 2 feet) of the wall was open with exposed pink insulation
- the door was ajar and could not be locked to prevent patient entry while the room was under repair

Based on observation, policy review and staff interview, it was determined that for 93 of 93 inpatients on 8/30/17, there were no towels available in the bathrooms used by patients for toileting and hand washing. Findings included:

The "Infection Control Officer/Nurse" job description stated, "...overall coordinator of the Infection Control Program..."

The hospital policy entitled "Infection Control Plan" stated, "...The Infection Control Nurse identifies areas of high risk to infection...Identified Priority Risks...Hand Hygiene...The ultimate goal of the Infection Control Program is to produce a safe environment for patients, staff and visitors by reducing the transmission of infectious disease..."

The hospital policy entitled "10 Tips for Preventing the Spread of Infection" stated, "...How to wash your hands...dry off hands with a dry paper towel or hand dryer. Use a paper towel to turn off the faucet if it is not an automatic style. Use a paper towel to open the door handle..."

A. During a tour of the facility on 8/30/17 between 9:50 AM and 11:10 AM, the following patient bathrooms lacked paper towels or another mechanism to dry hands:

Unit E: Room #3
Unit D West: Room #'s 12, 13, 14, 19, 20
Unit D East: Room #'s 22, 23, 24, 25 and 31
Unit C: Room #'s 40, 41, 42
Unit B: Room #'s 34, 36, 37 and 38
Unit A: Room #48

B. On 8/30/17 at 10:20 AM, Patient A stated that the patient's did not get paper towels so they could not flush them down the toilet.

C. On 8/30/17 at 11:10 AM, Patient B stated that:
- the patients were not given paper towels
- they had to ask staff at the nurses desk for paper towels
- "if I need to dry my hands, I wipe them on my clothes"

Nurse Coordinator C, who was present and witnessed these observations and interviews, confirmed these findings on 8/30/17 between 9:50 AM and 11:10 AM.