HospitalInspections.org

The Critical Access Hospital (CAH) reported an average daily census of seven patients with a current census of five skilled swing bed patients. Based on observation, staff interview, and policy review the CAH failed to ensure compliance of outdated supplies in one of one emergency department. This deficient practice had the potential to affect all current and future patients of the CAH in that it placed patients at risk for receiving ineffective treatments during an emergency.
Findings include:
- The CAH's policy reviewed on 9/14/15 at 3:24pm directed staff "...dated items must be checked by stock clerks to ensure that the items with the earliest expiration date are issued first...the manage performs a surveillance check at least once a month to verify the rotation of stock procedure is being implemented effectively...any supplies identified with an outdated expiration date will be removed from par levels, sequestered and disposed of...supplies delivered direct to departments upon receipt, must be check frequently by departmental staff for outdates/expiration dates...any supplies identified with an outdated expiration date will be removed from the department, sequestered and disposed of..."
- The Emergency Department (ED) observed on 9/14/15 between 9:50am-10:20am revealed the following outdated supplies in a cabinet in ED and a Broselow pediatric crash cart (pediatric emergency kit) containing life-saving supplies for airway and IV access:
1. One yellow pediatric Broselow pediatric emergency kit with an expiration date of 9/12.
2. One white pediatric Broselow pediatric emergency kit with an expiration date of 11/14.
3. One Blue Broselow pediatric emergency kit with an expiration date of 7/14.
4. One green Broselow pediatric emergency kit with an expiration date of 7/14.
5. One green Broselow pediatric emergency kit with an expiration date of 10/14.
6. One green Broselow pediatric emergency kit with an expiration date of 12/12.
7. Two 18 gauge spinal needles (needles used to administer medication) with an expiration date of 8/15 found in ED cabinet.
8. Two 25 gauge spinal needles with an expiration date of 4/14.

Adminitrative Nurse Staff A interviewed on 9/14/15 at 10:15am acknowledged the outdated supplies in the Emergency Room.

The Critical Access Hospital (CAH) reported an average daily census of seven patients with a current census of five swing bed patients. Based on observation, manufacturer's recommendations, and staff interview the CAH failed to ensure that unusable drugs and biologicals are not available for patient use in one of two surgical warming cabinets (sub sterile area cabinet). This deficient practice had the potential to affect all surgical patients requiring irrigation in that the irrigation might be ineffective.

Findings include:

- The manufacturer's information sheets for Hospira irrigation solution reviewed on 9/15/15 at 3:30pm directed, "...Solutions for irrigation in plastic flexible containers may be warmed for a period no longer than two weeks (14 days)...Solutions for irrigation in plastic pour bottles may be warmed for a period no longer than two weeks (14 days)..."


- The warming cabinet in the sub sterile area of the operating suite observed on 9/15/15 at 2:30pm revealed one 1,000 ml (milliliter) plastic flexible container of sterile Normal Saline ( a mixture of salt and water) 0.9% for irrigation and one 500 ml. plastic pour bottle of sterile Normal Saline 0.9%. These solutions lacked a date when placed in the warmer or the date the fluids were to be removed from the storage area.


Surgery Nurse Staff C interviewed on 9/15/15 at 2:30pm acknowledged one 1,000 ml plastic flexible container of sterile Normal Saline 0.9% for irrigation and one 500 ml. plastic pour bottle of sterile Normal Saline 0.9% lacked a date when placed in the warmer or the date the fluids were to be removed from the storage area.

The Critical Access Hospital (CAH) reported an average daily census of seven patients with a current census of five skilled swing bed patients. Based on observation, staff interview, and policy review the CAH failed to ensure that personal protective equipment was available for one of three flushable basins (used to rinse soiled items) in the CAH (emergency department soiled utility room basin). This deficient practice had the potential for spread of infection to staff of the CAH.
Findings include:
- The CAH policy titled "Infection Prevention & Control" reviewed on 9/16/15 at 3:45pm directed, "...personal protective equipment (PPE) in the appropriate sizes shall be readily accessible to all employees; PPE is strategically located for easy accessibility in each hospital department/unit...in situation where soaking of clothing is likely, the employer may provide a cover gown with a front panel that is reinforced or a plastic apron is to be used over a standard cover gown..."
- The soiled utility room of the Emergency room observed on 9/14/15 at 9:35am revealed a flushable basin without proper accessible personal protective equipment (PPE).
Maintenance Staff B interviewed on 9/14/15 at 9:35am acknowledged the lack of accessible PPE in the soiled utility room of the emergency department.

The Critical Access Hospital (CAH) reported an average daily census of seven patients with a current census of five skilled swing bed patients. Based on medical record review, Medical Staff Rules and Regulations review, and staff interview the CAH failed to ensure medical records are complete within 30 days for one of seven sampled skilled swing bed patients (patient # 30). The failure of the CAH to ensure medical records are complete has the potential to lead to poor patient outcomes for all patients admitted to the CAH.

Findings include:

- The CAH's "MEDICAL STAFF RULES AND REGULATIONS ANDERSON COUNTY HOSPITAL" reviewed on 9/16/15 at 11:50am directed "...the discharge summary must be recorded and signed by the attending Medical Staff Member, Physician Assistant or Advanced Nurse Practitioner authorized by his/her collaborating Physician Member for all patients within thirty (30) days of discharge. A discharge summary must be completed in the event of a patient's death..."

- Patient #30's medical record reviewed on 9/16/15 revealed an admission to skilled swing bed on 3/8/15 with a diagnosis of Urinary Tract Infection and death date of 3/20/15. Patient #30's medical revealed a discharge summary dictated by the physician on 5/1/15 (41 days after death). Patient #30's medical record failed to be completed within 30 days after discharge.

Administrative Nurse Staff A interviewed on 9/16/15 at 9:40am acknowledged Patient #30's discharge summary was dictated past 30 days. Administrative Nurse Staff A reported they did not know why the discharge summary was late.

The Critical Access Hospital (CAH) reported an average daily census of seven patients with a current census of five skilled swing bed patients. Based on medical record review, policy review, and staff interview the CAH failed to provide written notice of resident rights to one of seven sampled skilled swing bed patients (patient #30). The failure of the CAH to provide written notice of resident rights had the potential to affect all patients admitted as skilled swing bed patients and placed patients at risk of not knowing or understanding their rights.

Findings include:

- The CAH's policy titled "Resident Rights Swing Bed" reviewed on 9/16/15 at 3:10pm directed "...upon admission to the Swing Bed/Skilled Nursing Program, each patient will receive a copy of the "Resident's Rights and Responsibilities...A signed acknowledgment of the patient's receipt of the Resident Rights document will be made a part of the permanent medical record..."

- Patient #30's medical record reviewed on 9/16/15 revealed an admission to skilled swing bed on 3/8/15 with a diagnosis of Urinary Tract Infection and discharge date of 3/20/15. Patient #30's medical record lacked evidence of written notice of resident rights given to the patient.

Administrative Nurse Staff A interviewed on 9/16/15 at 9:40am acknowledged Patient #30's medical record lacked evidence they recieved their resident rights.