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Based on observation and interview, the Critical Access Hospital failed to ensure outdated, mislabeled, or otherwise unusable drugs and biologicals were not available for patient use as evidence by failing to remove expired emergency supplies from the crash cart.

Findings:

Review of the policy titled Crash Carts, Number OSMH.NURS.014, dated 08/01/2022, revealed in part: A. Checking Crash Carts: Adult and Pediatric: 1. The crash cart will be thoroughly checked after each use and monthly for supplies and to confirm that: a.) All supplies are on the cart and no supplies are outdated.

Observation on 01/23/23 at 11:15 a.m. of the emergency crash cart by the nurses station contained one 5.0 E-Tube expired date of 01/01/23, #4 Miller blade dated expired 11/09/22, #4 Miller blade dated expired 10/10/22, and a #2 Miller blade dated expired 11/10/22.

Review of the log book revealed the crash cart was checked for compliance on 11/07/22.

Interview on 01/23/23 at 11:20 a.m. with S6RN stated that nursing staff should be checking the crash cart monthly for expired supplies, and the expired supplies should be removed.

Based on record review, interview, and policy review, the Critical Access Hospital failed to ensure the nursing staff developed and kept current individualized and comprehensive nursing care plans. This deficient practice was evidenced by failure of the nursing staff to include all identified medical diagnoses and failure to include nursing interventions for 3 (#16, #18, #19) of 10 current sampled patients from a total sample of 20.

Findings:

Review of the hospital policy titled Documentation of Outcomes and the Nursing Plan of Care, Number OHS.NURS.OS.044, dated 02/07/2022 revealed in part: B. Each patient's care plan should address their specific needs. Monitoring the patient's progress toward projected goals/expected outcomes is an interdisciplinary, collaborative effort that occurs throughout the patient's stay and culminates at discharge.

Patient #16

Review of the medical record for patient #16 revealed an admit date of 01/20/23 with a diagnosis of Cellulitis, A-Fib, CAD, and HTN. Further review of the care plan revealed no goal or intervention for fluid volume deficit. Further review of the Physicians orders dated 01/20/23 revealed orders for Telemetry monitoring.

Review of the Care Plan for patient #16 revealed no care plan for cardiac goals and interventions, or telemetry monitoring.

Interview on 01/24/23 at 11:00 a.m. with S7RN confirmed there was no care plan addressing cardiac goals or interventions to include telemetry.

Patient #18
Review of the medical record for patient #18 revealed an admit date of 01/21/23 with diagnosis of HTN, Hypoxia, and COPD. Further review of the physicians orders dated 01/21/23 revealed orders for Oxygen therapy for NC 1-5L keep O2 sat above 88%, and Telemetry monitoring.

Review of the Care Plan for patient #18 revealed no care plan for goals and interventions for Oxygen therapy, and telemetry.

Interview on 01/24/23 at 11:40 a.m. with S7RN confirmed there was no care plan addressing goals or interventions to include Oxygen therapy or telemetry.

Patient #19
Review of Patient #19's electronic medical record with S6RN revealed an inpatient swing bed admit date of 01/15/2023. Review of the history and physical dated 01/15/2023 revealed, in part, blindness in both eyes

Review of the plan of care revealed, in part, no problem listed addressing Patient #19's blindness in both eyes with measurable goals, interventions and outcomes.

In interview on 01/25/2023 at 9:02 a.m., S6RN verified through electronic chart review Patient #19 had blindness in both eyes and the plan of care did not address this problem.


40548

The infection prevention and control program, as documented in its policies and procedures, employs methods for preventing and controlling the transmission of infections within the CAH and between the CAH and other healthcare settings;

Based on observation, interview and policy review the hospital failed to ensure its policy and procedure related to Operating Room Attire was followed to aid in preventing and controlling the transmission of infections within the CAH;s surgery suit as evidenced by S8Physician entering the surgery suit, restricted area without a surgical mask.

Findings:

A review of the hospital policy titled Operating Room Attire effective 01/11/2021 revealed in part:
III. Definition of Terms:
Restricted area: This area includes operating and procedure rooms. Surgical attire, face and hair coverings are required. Mask are required where open supplies or scrubbed persons may be located.

During an observation of the restoration, tooth extraction or dental prophylaxis with general anesthesia for Patient #1, S8Physician entered the surgical suite without a mask and walked around the surgical table to the far side of the room and sat to view a computer screen. He then spoke with several staff and exited the surgical suite without a mask. None of the staff directed S8Physician to utilize a mask in the surgical suite.

In an interview on 01/24/2023 at 9:50 a.m. S3DRPI verified S8Physician should have worn a mask the entire time he was in the surgical suite. S3DRPI said mask are required in the restricted areas and staff should have stopped S8Physician.