HospitalInspections.org

Based on observation, record review and interview, the CAH failed to ensure that drugs and biologicals were managed in a manner that is safe and appropriate by having outdated and unusable drugs available for patient use.

Findings:

Review of the CAH's Policy and Procedure for Beyond Use Date revealed: Multi-dose vials will be dated when opened and initialed by the nurse that opens the vial. These vials will be discarded after 30 days from the date opened.

Observation of the Emergency Department's treatment room on 03/11/2019 at 1:00 p.m. revealed the following:
a) 1- 1000 milliliter bag of 0.45% Sodium Chloride with an expiration date of 12/18.
b) 1 - Povidone Iodine prep solution with an expiration date of 2/19.
c) 1 - Bottle MultiStix Urine dipstick test strips opened and not dated
d) 1 - Bottle Dermal Wound Cleanser opened and not dated
e) 1- Bottle of peroxide opened and not dated.


During an interview on 03/11/2019 at 1:10 p.m., S1DON confirmed the expired drugs/biologicals, the opened and undated multi-use items and acknowledged the items should been discarded and not available for patient use.

Observation of the Emergency Department's exam room on 03/11/2019 at 2:20 p.m. revealed the following:
a) 1 - 1000 milliliter bag of 0.45% Sodium Chloride with an expiration date of 12/18.
b) 2 - Lubricating jelly packets with expiration dates of 06/18 and 09/18.

During an interview on 03/11/2019 at 2:30 p.m., S1DON confirmed the expired drugs/biolgicals and acknowledged the items should have been discarded and not available for patient use.

On 03/12/19 at 11:10 a.m., during observation of medication administration, S3LPN removed an opened multi-dose vial of Humalog 100 insulin from the automated dispensing cabinet and began to draw a dose of insulin from the vial. When questioned about the open date of the vial, S3LPN confirmed that the vial was not labeled with the open date or the expiration date. She further confirmed that insulin should not be used for greater than 28 days after opening the vial. She could not confirm the number of days the vial had been opened. She then discarded the medication she had prepared and opened an unused vial for the medication administration.

On 03/12/19 at 11:30 a.m., an interview with S1DON revealed that the medications are placed in the automated dispensing cabinet with a label on the bottle for the nurse to document the open date. The pharmacy is responsible for removing the expired and outdated medications from the cabinet. She confirmed that insulin should not be used beyond 28 days after opening and that the undated open vial of Humalog 100 insulin should not have stored in the automated dispensing cabinet with medications available for patient use.

Based on observation, record review and interview, the CAH failed to maintain a system for controlling infections and communicable diseases by: 1) failing to follow manufacturer's instructions for disinfecting a glucometer before and after patient use; 2) having expired patient supplies available for patient use and 3) failing to maintain patient care/use items.

Findings:

1) failing to follow manufacturer's instructions for disinfecting a glucometer before and after patient use:
On 03/12/19 at 10:40 a.m., observation revealed S3LPN was performing a finger stick blood sugar assessment for patient #7. S3LPN collected the supplies and cleaned the Nova Xpress 2 glucometer with an alcohol swab. After conducting the finger stick, S3LPN again swabbed the glucometer with alcohol and returned it to the storage case.

On 03/12/19 at 11:00 a.m., observation revealed S4LPN was performing a finger stick blood sugar assessment for patient #2. S4LPN collected the supplies and cleaned the Nova Xpress 2 glucometer with an alcohol swab. After conducting the finger stick, S4LPN again swabbed the glucometer with alcohol and returned it to the storage case.

Review of the Nova StatStrip Xpress 2 Glucose Hospital Meter System Quick Reference Guide, pages 12-15, revealed the following manufacturer's guidelines for cleaning and disinfecting the meter:
acceptable cleaning and disinfecting materials - bleach germicidal/disinfectant wipes with EPA Registration #67619-12;
1. Clean the Meter - wipe the external surface of the meter thoroughly with a fresh germicidal disinfecting bleach wipe. Discard the used wipe into an appropriate biohazard container.
2. Disinfect the Meter - using a new, fresh germicidal bleach wipe, thoroughly wipe the surface of the meter (top, bottom, left and right sides) a minimum of 3 times horizontally followed by 3 times vertically...gently wipe the surface of the test strip port...
3. Observe surface contact time - ensure the meter surface stays wet for 1 minute and is allowed to air dry for an additional minute.

On 03/12/19 at 11:45 a.m., an interview with S1DON confirmed that the nursing staff were not cleaning and disinfecting the glucometer before and after patient use according to the manufacturer's guidelines.


2) having expired patient supplies available for patient use:
Observation of the Emergency Department's treatment room on 03/11/2019 at 1:00 p.m. revealed the following:
a) 33 - 18x26" Sterile Field packets with an expiration date of 11/18.
b) 1 - Culture vial with an expiration date of 02/28/2019
c) 8 - Culture Swab Collection sets with an expiration date of 2/28/19.
d) 1 - Dermablade with an expiration date of 12/18.
e) 1 - Povidone Iodine prep solution with an expiration date of 2/19.

During an interview on 03/11/2019 at 1:10 p.m., S1DON confirmed the expired supplies and acknowledged the supplies should been discarded and not available for patient use.

Observation of the Emergency Department's exam room on 03/11/2019 at 2:20 p.m. revealed the following:
a) 1 - Bard Piston Irrigation Tray with an expiration of 09-2016.
b) 1 - Box 3-0 Vicryl Sutures with an expiration date of July 2018.
c) 1 - Box 4-0 Gut Plain Sutures with an expiration date of January 2019.

During an interview on 03/11/2019 at 2:30 p.m., S1DON confirmed the expired supplies and acknowledged the supplies should have been discarded and not available for patient use.


3) failing to maintain patient care/use items:
Observation of the therapy treatment room on 03/12/2019 at 1:00 p.m. revealed the patient's exercise cycling machine had a rip/tear to the vinyl covering of the seat.

During an interview on 03/12/2019 at 1:15 p.m., S9PTA confirmed the findings and acknowledged the rip/tear to the vinyl seat cover prevented the patient's equipment from being properly sanitized.

Observation of the x-ray room on 03/12/2019 at 1:35 p.m. revealed rips/tears to the vinyl covering of the patient's pillow used on the exam table.

During an interview on 03/12/2019 at 1:40 p.m., S10Radiology confirmed the findings and acknowledged the rip/tear to the pillow's vinyl cover prevented the patient's equipment from being properly sanitized.

Based on record review and interview, the CAH failed to ensure the registered nurse supervised and evaluated the care provided to patients by failing to ensure continuous monitoring for 2 (Patient #11 and #12) of 3 patients diagnosed with suicidal thoughts (Patients #10, #11 and #12).
Findings:

Review of the facility's Policy and Procedures "Suicide Precautions" revealed in part:
Policy:
- To provide and maintain a safe environment for those patients who are a suicidal risk.
- Suicidal Risk: indicates the potential for suicide attempt, based on the patient exhibiting danger signs or risk factors for suicide but not limited to: Presence of suicide plan; Admission for a suicide attempt; Suicidal ideation.

Procedure:
- Precautionary measures can be put in place by the nurse caring for the patients who may present suicidal risk.
- Provide constant direct observation of the patient.
- Documentation: Staff document checks every 15 minutes on the Suicide Precautions Care Provider Record.

Review of Patient #11's medical record revealed an admit date of 8/25/2018 with a diagnosis of suicidal ideation with plan. Further review of the medical record failed to reveal direct patient observation was documented every 15 minutes.

Review of Patient #12's medical record revealed an admit date of 10/27/2018 with a diagnosis of suicidal ideation and suicide attempt. Further review of the medical record failed to reveal direct patient observation was documented every 15 minutes.

After review of Patients #11's and #12's medical records, S2ADON acknowledged on 3/12/2019 at 12:20 p.m. that there was no documentation the patients were being directly observed.

Based on record review and interview, the CAH failed to ensure care plans were developed and kept current for each patient by failing to include discharge planning for 15 of 15 patients reviewed in a total sample of 20 patients.
Findings:

Review of the medical records for patients #1, 2, 3, 4, 5, 6, 7, 13, 14, 15, 16, 17, 18, 19 and 20 revealed no evidence that discharge planning assessments and care plans had been developed.

On 03/12/19 at 2:30 p.m., an interview with S2ADON confirmed that discharge planning assessments were not documented and care plans had not been developed for discharge planning for the above patients.