HospitalInspections.org

Based on review of facility documentation, medical record (MR), and staff interview (EMP), it was determined that the facility failed to follow nursing care policies and procedures consistent with professionally recognized standards of nursing practice for one of four medical records reviewed (MR1).


Findings include:


Review of facility policy and procedure "Peripherally Inserted Central Catheter (PICC)" revised March 2017, revealed "A physician order is required for PICC insertion. A PICC can also be inserted in Medical Imaging by a radiologist if venous access does not permit insertion by an IV Specialist."

Review of facility policy and procedure "Central Venous Catheter (CVS) Care & Maintenance" dated September 20, 2014, revealed "Assessment: ... Assess venous access, for need for central placement ... b. One arm only due to mastectomy, fistula, infection ... 2. Initiate the following for all identified contraindications fistula, history of mastectomy, PICC Line in place) a. Place green arm band on affected arm b. Enter into SCM ... c. Post sign above patient's bed" Further review revealed the green arm band states "DO NOT USE THIS EXTREMITY."

Review of facility policy and procedure "Patient Identification" dated October 25, 2017, revealed "4. Identifying Patient-specific Precautions a. Upper Extremity Protection i. The patient who requires upper extremity protection will have a pre-printed green band indication "Do Not Use this Extremity" applied to the affected extremity. A sign will also be posted at the bedside to inform staff that the extremity should not be used for procedures such injections, venipunctures, monitoring of blood pressure, etc."

1. Review of MR1 revealed "Focus Note ... 9/7/2017 11:27 AM ... PICC insertion in right basilic with tip in right jugular. Picc removed due to hx of DVT in right arm."
2. Review of facility documentation "Event Details ... Charge nurse looked into issue; apparently IV team was inserting PICC ... until they realized that arm was not to be used & DC'D (discontinued)line."
3. Review of MR1 revealed "Current Summary ... Entered Date: 09/08/2017 ... Event Detail ... Attempt to insert PICC in prohibited arm."

4. Review of MR1 "ED Report ... 9/3/2017 2:07:00 PM ... Chief Complaint: Left foot pain. ... Past Medical History: ... DVT of the right upper extremity... ."

Interview with EMP5 on November 15, 2017, at approximately 10:45 AM confirmed the above findings and revealed "When the preceptor came back she went thru the steps with her and when she asked about the green band they realized she put it [PICC] in an arm that was not allowed."

Based on review of facility documentation and staff interview (EMP), it was determined that the facility failed to provide appropriate referrals for inpatients requiring services that the facility did not provide in regards to MRI Services.

Findings include:

1. During the survey the surveyor observed a documentation "Patient To Be Taken Offsite For MRI ... To Be Completed By MRI Supervisor: ... The Patient Is Being Sent To ..."

2. Interview with EMP1 on November 15, 2017 at approximately 12:00 PM when asked if the facility was taking inpatient's out of the hospital to a outpatient facility revealed "yes if a patient requires the larger MRI we do take them out to our ... to get the MRI done because they do not fit in the one in the hospital. They are transported by ambulance with a nurse and returned."

3. A request was made to review a policy for the above process and none was provided.

4. Review of a list of patient's that were transferred to the outpatient facility from December 14, 2015 thru September 28, 2017, revealed a total of 46 patient's transferred. Further review revealed three of the 46 patient's were transferred on two separate dates.