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Based on direct observation and medical record review, the hospital failed to ensure medications were administered as ordered by the physician. This affected one of three patients observed during medication administration, (Patient #33). The hospital census at the time of the survey was 79.

Findings included;

Patient #33 was observed on 06/16/10, during the morning hours, for medication administration by Employee Q. Employee Q was observed to crush two tablets of Flagyl (antibiotic) 250 mg each, for a total dose of 500 mg. The crushed medication was placed in applesauce and administered by spoon to Patient # 33. The medical record for Patient #33 was reviewed after the observation of the medication administration. The physician's order for this medication read; "Flagyl 250 mg four times a day". Further review of the medical record revealed the nurse had also documented administration of 500 mg of Flagyl. These findings were reviewed with Employee L immediately following the drug administration.

Employee Q was also observed to crush Wellbutrin XL during this medication pass. The medication administration record contained a warning from pharmacy regarding Wellbutrin XL. The warning stated, "Do not crush or chew..." These findings were shared during interview with Employee L on 06/16/10, during the morning hours immediately following the drug administration. Employee R was interviewed, on 06/17/10 at 1:00 P.M., regarding the crushing of Wellbutrin XL. Employee R stated the medication was an extended release medication and crushing the medication rendered it immediate release. Employee R confirmed the order was for the extended release form of the medication.

Based on staff interview and direct observations, the facility failed to ensure information from the medical records posted on communication boards were not communicated to unauthorized individuals for two ( patients # 33, #34) and medical records protected against possible unauthorized individuals review related to unsecured medical record storage. The sample size was 35 patients reviewed. The deficient practice involved patients residing two. The patient census was 79.

Findings include:


Observations were conducted on the fifth floor, medical surgical and telemetry units during the morning hours on 06/16/10. The medical records for all patients on the fifth floor were noted to be stored in unlocked cabinets in the hallway outside each patient's room. Medical records were accessed by opening the cabinets, with no intervention noted to prevent access by unauthorized individuals.

Patient #33 was observed in his/her room on the fifth floor during a medication administration on 06/16/10, during the morning hours. The wall across from the patient's hospital bed contained a dry erase board. The dry erase board contained notes which stated; "sm. open sore coccyx, sm. open sore ? abd. hernia sore, 2x small open sore diaper rash." The note listed the measurements of the patient's wounds. The dry erase board was in plain view of anyone entering the patient's room. This finding was confirmed with Employee L on 06/16/10, at 2:30 P.M.



07306

On 06/16/10, between 5:00 P.M. and 5:30 P.M., observations were made on the fourth floor. In Patient #34's room a dry erase communication board was seen posted on the wall. The communication board stated "Percocet one to two tablets every four hours as needed for pain." The communication board was visible to any persons entering the patient's room. Interview with Staff #T, on 06/16/10 at 5:31 P.M., confirmed the posted medical information was confidential information. Staff #T stated, at 5:31 P.M., the information had been documented on the communication board by another staff member. Interview with Staff #S, on 06/16/10 between 5:30 P.M. and 5:35 P.M., revealed this type of patient information was not to be posted on the communication board. Staff #S confirmed, during this interview, the information posted was confidential and was accessible to unauthorized persons.

Based on medical record review and staff interview, the hospital failed to ensure the nurse acknowledged physician orders for two of six surgical patients reviewed, (Patients #4 and #5). The sample size was 35 patients reviewed. The hospital census at the time of the survey was 79.

Findings included;

The medical record for Patient #4 was reviewed on 06/15/10. The patient was admitted for an outpatient inguinal hernia repair. The medical record contained evidence of an ambulatory care unit post procedure order set. The order set was signed with the date and time by the physician. The order set lacked evidence the nurse caring for the patient had verified and signed the orders to indicate he/she had acknowledged them.

The medical record for Patient #5 was reviewed on 06/15/10. The medical record contained evidence of a Post Anesthesia care unit order set which was dated, timed and signed by the physician. The order set lacked evidence the nurse caring for the patient had verified and signed the orders to indicate he/she had acknowledged them. The ambulatory care unit post procedure order set was dated, timed and signed by the physician. This order set also lacked evidence the nurse caring for the patient had verified and signed the orders to indicate he/she had acknowledged them. These findings were confirmed with Employee L on 06/15/10 at 4:45 P.M.

Based on observation, policy review, and staff interview, it was determined the hospital failed to ensure cooking utensils were stored in a clean manner, failed to ensure food temperatures were recorded, and failed to ensure the ice machine was maintained to prevent potential contamination from the water drain. The hospital census was 79.

Findings include:

On 06/17/10 a tour of the dietary department was taken with Staff #U and V between 10:00AM and 11:50AM. The ice machine was seen to have a drainage pipe that was directly positioned into the drainage (contaminated) port in the floor. There was no air gap(space) between the drainage pipe from the ice machine and the floor contaminated drainage port to prevent contamination of the ice in the event of sewage backflow. Interview with Staff #U, on 06/17/10 at 10:30 A.M., revealed he/she was not aware there should be a space between the drainage pipe from the ice machine and the sewage port.

Further observation on 06/17/10 with Staff #U and V between 10:00 A.M. and 11:50 A.M. revealed clean cooking utensils (whisks,spatulas, tongs, knives) were stored in drawers that also contained non-cooking items such as pot holders, cleaning cloths, and ink pens. Staff #U verified cooking utensils were to be stored in the clean area only and were not to be stored with non-cooking equipment. In addition, on 06/17/10 at 11:00 A.M., a large paper drinking cup was seen stored on the shelf where the hot food was dipped for patient meals. Interview with the cook at this time revealed the drinking utensil belonged to the cook (that was dipping the hot foods for service). The cook stated at this time the cup contained his/her drinking water.

Review of the dietary policy titled "Food Safety Program and Training", on 06/17/10 at 1:00 P.M., revealed temperature for prepped food items must be recorded at least twice daily in the temperature logs and kept on file for one year. Review of the temperature logs on 06/17/10, revealed food temperatures were only recorded one time on 06/03/10, 06/05/10, and 06/06/10. These findings were verified with Staff #U on 06/17/10 at 10:48 A.M.

Based on observations and staff interviews, the condition of participation for physical environment is not met as the facility failed to: maintain latching stairwell doors, repair the penetrations in the smoke barriers, maintain the self closure on smoke barrier door, ensure the light switch in the gas storage room was at least 5 feet from the floor, and ensure smoke detectors were not obstructed by air flow. The patient census was 79.

Findings include:

The facility failed to ensure the physical envioment was maintained to protect the safety and well-bing of all patients. Refer to A701,482.41(a) Buildings.

Based on observations and staff interviews, the facility failed to ensure the safety and well-being of all patients was maintained in the physical environment. The patient census was 79.

Findings include:

The facility failed to ensure all stairwell doors latched securely. Refer to K20

The facility failed to ensure wall penetrations in smoke barriers were repaired. Refer to K25.

The facility failed to ensure all doors in smoke barriers were self- closing. Refer to K27.

The facility failed to ensure all medical gas storage room light switches were located at least 5 feet from the floor. Refer to K76.

The facility failed to ensure all smoke detectors were located so air flow was not obstructing the intended operation of the detectors. Refer to K130.