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Based on record review and interview, the facility failed to ensure the discharge summary included the patient's disposition, in that, 3 of 4 discharged patient's (Patient #15, #16, and #17) discharge summary did not designate their correct disposition at discharge.

Findings included

Patient #15's, #16's, and #17's discharge summary did not designate their correct disposition at discharge.

During a electronic record review and interview on 7/05/16 ending at 3:50 PM, Personnel #25 and Personnel #26 were asked for the discharge summary for each of the above listed patients. Personnel #26 showed the surveyor each discharge summary. Personnel #26 was informed each summary did not contain the disposition (continued health care plan upon discharge from the facility) for the respective patients. Personnel #26 reviewed each of the discharge summaries and stated, "I do not see (the correct disposition) it.

The undated "TMC (Texoma Medical Center) Medical Staff Rules & Regulations" required, "the discharge summary shall include...Condition of patient on discharge...Disposition of the patient...Specific, pertinent instructions given to the patient...including instructions relating to physical activity, medication, diet, and follow-up care...The condition of a patient discharge should be stated in terms that permit a specific measurable comparison with the patient's condition at admission..."

Based on observation, interview, and record review, the facility's 1 of 2 provider-based off-site location (Cardiac Rehabilitation) was found to have a drug (Nitroglycerin lingual spray) that was unsecured and located in the patient care area.

Findings included:

A tour was conducted on 07/06/16 at 2:50 PM in the Cardiac Rehabilitation unit located off-site with Personnel #49. The surveyor observed a "Nitroglycerin lingual spray 0.4 mcg/spray (60 metered spray)" on a counter in the patient care area.

In an interview on 07/06/16 at 2:55 PM, Personnel #49 confirmed the medication was unsecured in the patient care area for easy accessibility if needed.

Facility policy "Medication Security..." reviewed 01/2016 required "4...Storage - Patient care areas will store medications in an approved, lockable storage cabinet...until prepared for administration."

Based on observation, interview, and record review, the facility's infection control officer did not ensure the following infection control issues were addressed:

A. 1 of 1 staff member (Personnel #54) who was observed providing wound care in the nursing floor did not sanitize her hands after removing her gloves and 2 of 5 direct patient care providers (Personnel #8 and Personnel #9) in the operating room (OR) were observed not performing hand hygiene after removing their gloves;

B. 1 of 1 surgical bed's mattress had small open areas in the head of the bed (HOB), foot of the bed, and the removable right side arm in the OR #9;

C. 1 of 2 surgical technicians (Personnel #11) opened a pack of sterile surgical towels which fell on the floor. Personnel #11 picked the towels up from the floor and placed it on the patient's clean bed;

D. 1 of 5 direct patient care providers in the OR (Physician #6) did not completely restrain his hair in that his side burns and hair at the nape of his neck were showing;

E. 1 of 1 black porous computer bag was observed in the hallway of the restricted area near OR #8;

F. 1 of 1 hemodialysis nurse (Personnel #17) opened a package of arteriovenous fistula (AVF) needles, removed the AVF needles out of the package, and laid the AVF needles on top of the bedside table; and

G. 1 of 1 hemodialysis nurse (Personnel #17) opened 2 Lidocaine vials and inserted a tuberculin syringe needle in each Lidocaine vial without disinfecting the Lidocaine vials' rubber stopper and aspirated Lidocaine.

Findings included:

A. On 07/05/16 at 2:15 PM on the nursing floor, Personnel #54 was observed providing wound care to Patient #1's pressure ulcer on the area of her sacrum. After Personnel #54 finished applying the dressings she didn't remove her gloves and sanitize her hands until after she touched the patient's arm, arranged the bed covers and gathered wound care supplies.

During an interview on 07/05/16 at 2:40 PM with Personnel #3 who was present during Patient #1's wound care, she confirmed the above observations.

Tracer Patient #21 was scheduled for left knee arthroscopy on 07/06/16 at 10:00 AM in OR #9. The surveyor and Personnel #3 followed the tracer patient to the OR. During the procedure the following was observed:

- Personnel #8 intubated Patient #21 at 10:07 AM and removed her soiled gloves. Without performing hand hygiene, Personnel #8 put on a pair of clean gloves and assisted in repositioning Patient #21. Personnel #3 was informed of the findings and she confirmed the findings.

- Personnel #9 applied a tourniquet to Patient #21's right lower extremity at 10:15 AM and she removed her soiled gloves. Without performing hand hygiene she put on a pair of sterile gloves and then disinfected Patient #21's left knee and the rest of the lower extremity.

B. On 07/06/16 at 9:05 AM a surveyor and Personnel #3 went to the OR #9 and observed the cleaning and/or disinfecting of the room. The surveyor observed the surgical bed's mattress had scattered small open areas in the head of the bed (HOB), foot of the bed, and the removable right side arm. The surgical bed's mattress could not be properly sanitized and/or disinfected because of the open areas. Personnel #3 confirmed the findings.

C. On 07/06/16 at 9:37 AM in OR #9 the surveyor observed Personnel #11 opened a pack of sterile surgical towels. The sterile towels fell on the floor and Personnel #11 picked the towels up from the floor and placed them on the patient's clean bed. Personnel #3 confirmed the findings. Personnel #43 took the surgical towels from the clean bed and placed it in the dirty linen bin.

D. Physician #6 entered the OR #9 on 07/06/16 at 10:25 AM and was observed wearing an ineffective hair restraint. His sideburns and the hair at the nape of his neck were showing. Personnel #3 who was present in the OR confirmed the findings.

E. On 07/06/16 at 10:45 AM the surveyor observed a black porous computer bag in the hallway of the restricted area near OR #8. Personnel #3 was asked who the computer bag belonged to. Personnel #3 replied she was unsure. Personnel #3 was asked to provide the surveyor a policy and procedure for items brought to the restricted area. Review of the policy "Surgical Attire..." reviewed 06/2016 page 3 required "...personal items that are taken to the semi-restricted or restricted areas should be cleaned...if the material is porous...it should be placed in a plastic bag for protection..."

In an interview on 07/06/16 at 3:30 PM Personnel #23 was informed of the above infection control issue findings and confirmed the findings.

The facility's policy "Hand Hygiene" reviewed 03/11/16 required "Hospital personnel will perform hand hygiene...after removing gloves..."

The facility's policy "Surgical Attire..." reviewed 06/2016 required "IV. 5. All personnel must cover head and facial hair, including sideburns and the nape of the neck when in the semi-restricted and restricted areas."

F. During a tour of the facility's hemodialysis unit on 7/6/16 the surveyor observed the following:
~ At 9:05 AM, a hemodialysis nurse (Personnel #17) opened a package of arteriovenous fistula (AVF) needles, removed the AVF needles out of the package, and laid the AVF needles on top of the bedside table. When personnel #17 was asked why she took the AVF needles out of package, she replied that a patient is on the way for treatment in about 20 minutes and that she was getting ready for the patient's treatment.

This finding was confirmed in an interview with personnel #18 on 7/6/16 at 9:10 AM. When personnel #18 was asked if the AVF needles were supposed to be opened and laid on top of the bedside table, she replied, "No, not until the patient is here, the supplies are not opened."

G. At 9:30 AM, a hemodialysis nurse (Personnel #17) opened 2 Lidocaine vials and inserted a tuberculin syringe needle in each Lidocaine vial without disinfecting the Lidocaine vials' rubber stopper and aspirated Lidocaine.

This finding was confirmed in an interview with personnel #18 on 7/6/16 at 9:32 AM. When personnel #18 was asked if the Lidocaine vials needed to be disinfected prior to the insertion of the tuberculin syringe needle, she replied, "Yes."

DaVita HealthCare Partners, Inc. Acute Services Policy & Procedure, #1 Infection Control in The Hospital Dialysis Setting Policy dated 9/2015, included, "...1. DaVita dialysis teammates will follow hospital..."

Texoma Medical Center Medication Administration Policy dated 4/2012, included, "...5. Follow aseptic technique during medication preparation...withdrawal of medication...3. Vial disinfected with alcohol pre pad..."







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Based on record review and interview, the facility failed to ensure necessary medical information was transferred to the appropriate facilities, agencies, or outpatient services, as needed, for follow-up or ancillary care, in that, the facility could not evidence necessary medical information had been transferred to each patient's appropriate/respective post discharge providers for 3 of 4 discharged (Patient #16, #17, and #18) patients.

Findings included

Patient #16's, #17's, and #18's record did not evidence necessary medical information had been transferred to each patient's appropriate/respective post discharge provider.

During an electronic record review and interview on 7/05/16 ending at 3:50 PM, Personnel #25 and #26 were asked for evidence of necessary medical information transferred to each patient's appropriate/respective post discharge providers. Personnel #26 reviewed the patient's records and stated, "I can't see that records were sent."