HospitalInspections.org

Based on a tour of the Emergency Room (ER) and the ER waiting room and interviews with patients/caregivers and the ER Nurse Manager (Employee Identifier - EI # 2), it was determined the facility failed to ensure the hospital environment was maintained in a manner that was safe for the patients, visitors and staff. This had the potential to effect all the patients, visitors and staff.


Findings include:

An initial tour of the ER Department and ER waiting room area was conducted on 6/15/10 at 12:00 PM. During this tour, the surveyor observed the restrooms, which were designated as ER waiting room restrooms. The surveyor observed toilet paper pieces on the floor of the Men's restroom. The floor and walls of the Men's restroom were dirty in appearance. The surveyor then observed the Ladies restroom floors and walls were also dirty in appearance.

The surveyor then observed the floor was dirty in appearance in a Male/Female restroom located in the ER Department.

An interview was conducted on 6/15/10 at 12:05 PM with a patient who was waiting to be seen in the ER waiting area. During this interview, the surveyor asked the patient how long he/she had been waiting. The reply was since 11:30 AM. The surveyor asked the patient if he/she had been to the ER in the past. The reply was, "several times". The surveyor then asked the patient if he/she had used the restroom while here. The reply was, "yes". The surveyor then asked if it was clean. The reply was, "sometimes".The patient then stated, "the restroom was cleaner during the day, never been too bad, though."

At 12:15 PM, the surveyor then questioned a family member of another patient. The surveyor asked how he/she had been waiting. The reply was, "we have been here since 8:00 AM..." The surveyor then asked if he/she had used the restroom while here. The reply was, "I went to the bathroom in the back (ER Department)." The surveyor then asked if the restroom was clean. The reply was, "It was clean for a hospital restroom."

The surveyor toured the remaining portion of the ER Department on 6/15/10 at 1:50 PM. During this tour, the surveyor observed the following: Rooms 4A & 4B - walls were stained and had holes in them
Rooms 5A & 5B, 6A & 6B - baseboards were dirty
Rooms 7A & 7B - base boards were chipped
Restroom in the "Medical Area" (Non-Emergent area) - toilet paper scraps on the floor and the floor was dirty in appearance.

During this tour the surveyor asked EI # 2 about housekeeping services. EI # 2 stated they have housekeeping services 24 hours a day/7 days a week, 2 housekeeping staff during the day, 2 during the evening and 1 at night time. EI # 2 stated the housekeeping staff wax/strip the floors about 1 time a week.

Based on observation, interviews with the staff, review of acceptable standards of practice, it was determined the facility failed to ensure the nursing staff followed standards for suctioning a patient's oropharyngeal area. This had the potential to effect all patient's who were suctioned.

Findings include:

Acceptable Standard of Practice: Suctioning

Fundamentals of Nursing by Potter- Perry 6th Edition

page 1103

A. Oropharyngeal Suctioning

(After Suctioning)

(6) Suction water from basin through catheter until catheter is clear of secretions. Clearing secretions before they dry reduces probability of transmission of microorganisms and enhances delivery of preset suction pressures.

An observation of care provided by the nursing staff occurred on 6/15/10 at 12:25 PM. A Registered Nurse (RN) entered Intensive Care Room (ICU) # 15 to suction the patient. The RN suctioned the patient's oropharyngeal area. The RN put the suction yanker in the sleeve without rinsing.

An interview was conducted with Employee Identifier (EI) # 1, the Nurse Manager of the ICU. The surveyor asked if EI # 1 would expect Nursing Staff to rinse the yanker before replacing in sleeve and the response was yes.