HospitalInspections.org

Based on findings from facility document review, observation and interview, nursing staff did not check the emergency department's (ED) pediatric Broselow emergency cart daily to ensure availability and condition of resuscitation equipment.

Findings include:

-- Per review of the facility's policy and procedure (P&P) titled "Code Blue Cart and Electrical Defibrillator Checks," last reviewed 2/2015, it instructed nursing staff to check for the presence of Broselow Pediatric Emergency Tape for weight classification and Broselow flip chart for emergency treatment algorithms daily and document on the Code Blue Cart Check Log.

-- Per observation of the pediatric Broselow emergency cart and review of the Code Blue Cart Check Log on 10/27/15 at 11:00 am, the Log lacked documented evidence that nursing staff checked for the above equipment.

-- Per interview on 10/27/15 at 12:05 pm with Staff A, he/she does not check the pediatric Broselow emergency cart.

-- During interview on 10/27/15 at 12:30 pm with Staff B, he/she acknowledged the above findings.

Based on findings from observation, document review and interview, sample medications located in the hospital's extension clinic (Primary Care Center at Newport) were not accurately recorded in the sample medication log.

Findings include:

-- Per observation on 10/28/15 at 1:10 pm, the sample medication closet contained 4 boxes a Dulera, 200 mcg (microgram)/5 mcg with the lot number K011434SA. However, per review of the sample medication log, it indicated the lot numbers were J006190 (for 1 box), J013385 (for 2 boxes) and K000787 (for 2 boxes).

The sample medication closet also contained boxes of Dulera 100 mcg/5 mcg and Spiriva 18 mcg. However, the sample medication log did not contain these medications.

-- During interview on 10/28/15 at 1:10 pm with Staff C, he/she confirmed the above findings.

Based on findings from observation, interview and document review, in 1 of 2 observations, infection control precautions were not maintained as required by hospital policy and procedure (P&P).

Findings include:

-- Per observation on 10/27/15 at 1:30 pm, Patient #1 had signage posted outside her door indicating she was on droplet precautions. The signage indicated a mask should be worn while in the patient's room. A visitor in Patient #1's room was not wearing a mask.
Per interview of the visitor, at the time of observation, when asked, she indicated she had not been instructed to wear a mask when in Patient #1's room.

-- Per hospital P&P titled "Precautions for the Prevention of Infections," last reviewed/revised 8/2015, it indicated all persons entering the room of a patient on droplet precautions put on a clean mask and dispose of the mask when exiting the room. Additionally, family members or visitors should follow the same use of personnel protective precautions as staff. Staff will instruct the visitors on the appropriate use of protective equipment.

-- During interview on 10/27/15 at 1:30 pm with Staff D, he/she acknowledged the above findings.

Based on findings from medical record (MR) review, facility document review, interview and observation, in 3 of 7 MRs, nursing staff did not document turning and positioning every two (2) hours for patients at risk for skin breakdown as required by policy and procedure (P&P). Also 1 of 6 emergency department (ED) MRs reviewed, for patients identified as a risk to fall, fall prevention measure were not in place as required by P&P.

Findings include:

-- Per review of Patient #2's MR, he was admitted to the hospital on 9/16/15 for physical deconditioning and status post right below the knee amputation. His Braden Scale score was 15 indicating the patient was "at risk" of pressure ulcer development. From 9/16/15 at 8:51 am to 9/26/15 at 11:00 am, there was no documentation nursing staff turned and positioned the patient every 2 hours and/or the patient was able to reposition himself.

The same lack of documentation regarding turning and positioning patients at risk for skin breakdown every 2 hours was found in MRs for Patient #3 from 9/3/15 at 9:00 pm to 9/4/15 at 10:58 am, and Patient #4 from 10/7/15 at 9:00 pm to 10/8/15 at 3:00 pm.

-- Per review of the hospital's P&P titled "Pressure Ulcer Prevention Protocol" undated, it indicated all patients scoring a 18 or less on the Braden Scale are to be repositioned at least every two hours and to document in the MR.

-- During interview on 10/29/15 at 11:00 am with Staff D, he/she acknowledged the above findings.

-- Per review of ED Patient #5's MR, she was identified as a high risk to fall per the Hendrich II Fall Scale (hospital's fall risk assessment tool).

-- Per review of the facility's P&P titled "Fall Prevention Protocol," last approved 5/2014, it indicated ED patients deemed to be at risk of falling will be identified by signage placed above the head of the bed and outside the room, a yellow "fall" sticker placed on the patient's identification bracelet and bed check alarms and personal alarms will be engaged at all times.

However, per observation on 10/27/15 at 10:15 am, Patient #5 did not have a yellow "fall risk" sticker on her identification bracelet. A sign was not placed above her bed or outside her exam room. She did not have a bed alarm.

-- During interview on 10/27/15 at 10:30 am with Staff B, he/she acknowledged the above findings.