HospitalInspections.org

Not Corrected

Based on record review and staff interview, the CAH (Critical Access Hospital), failed to ensure that for 3 patients, (#1, #4, and #5), in a total sample of 5 patients, that the patient's intravenous access devices were flushed in accordance with the physician's order and/or the CAH Policy for Intermittent Infusion Devices.

Findings included:

Review of the CAH's policy for Intermittent Infusion Devices, indicated that each intermittent infusion device must be flushed with 2.5 ml of saline following each administration of medication or every 12 hours, whichever occurs first. The policy also indicated to "Scan and document medication given in Med Verify system each time a saline flush is given."

1. Patient #4 was admitted in 11/2015 with diagnoses which included diabetes mellitus and cellulitis of the bilateral lower extremities.

Record review on 11/17/15, indicated that the patient had a saline lock and was receiving Vancomycin 1.75 grams IV every 36 hours. A physician's order was written on 11/15/15 to flush the saline lock with 10 ml of normal saline PRN (as needed) directed.

Review of the eMAR indicated that the saline lock had not been flushed since the Patient was admitted on 11/12/15. Additionally, on 11/16/15 at 10:46 P.M., the nurse documented that Acteplase (used to dissolve blood clots) had to be administered to the purple port due to clogging of the port.

2. Patient #1 was admitted to the CAH in 11/2015 with diagnoses which included left leg infection and status post toe amputation right foot.

Record review on 11/17/15, indicated that the patient had a saline lock and was receiving the antibiotic Vancomycin 2 grams IV (intravenously) every 12 hours. A physician's order was written on 11/14 /15 to flush the saline lock with 5 ml (milliliters) of normal saline every 8 hours.

Review of the eMAR (electronic medical record) indicated that the saline lock had not been flushed at any time since the Patient was hospitalized on 11/14/15.

Interview with RN #1 on 11/17/15 at 12:15, confirmed that there was no documented evidence that the saline lock had been flushed according to the physician's order.

3. Patient #5 was admitted in 11/2015 with diagnoses which included bacterial pneumonia and cellulitis of the right leg.

Record review on 11/17/15, indicated that the Patient had a saline lock and was receiving Vancomycin 1.75 grams every 24 hours, Azithromycin 500 mg IV every 24 hours, and Ceftriaxone 1 gram IV every 24 hours. An order was noted in the eMAR to flush the saline lock with 2 ml of normal saline PRN per the flush protocol.

Further review of the eMAR indicated there was no documented evidence to demonstrate that nursing had flushed the saline lock in accordance with the physician order or the Hospital policy.

During an interview on 11/18/15 at 1:45 P.M., the Vice President (V.P.) of Nursing and the V.P. of Compliance said that nursing staff had failed to follow the Hospital policy for the care and treatment of intermittent infusion devices.

Based on observation and staff interviews during the follow-up survey, the Critical Access Hospital (CAH) failed to properly maintain medical records in a manner that was protected from water damage.

Findings include:

Observation of the closed medical record room storage, on the CAH's First Floor, on 11/17/15 at 1:50 P.M. with the Director of Medical Records, revealed 20 rows of closed medical records, stored in two rooms, in open-faced metal cabinets. The closed medical records were not totally enclosed in the metal cabinets. As a result, medical records were not stored so as to prevent their destruction from damage from the water sprinkler system.

During interview on 11/17/15 at 2:00 P.M., the Director of Medical Records said that the current storage of medical records did not provide an effective protection of closed records if a fire occurred and the sprinkler system was engaged.