HospitalInspections.org

Based on review of hospital documents, nursing policies and procedures, and interviews with staff the hospital failed to follow perioperative policies and procedures.

Findings:

1. On 4/4/2012 surveyors requested policy and procedure manuals surgery, anesthesia, and central sterile. Review of the surgery manual indicated policies had been reviewed and approved in 2012. The facility also provided the current Association of periOperative Registered Nurses (AORN) Standards and Recommended Practices. . According to the policy "Fire Safety" D. Is an ESU (electrosurgical unit), laser, or fiber-optic cord being used? Actions-fiber optic light cord use: Place the light source in standby mode or turn it off when the cable is not in active use (eg, used within 5 to 10 seconds). Inspect light cables before use and remove from service if broken light bundles are visible. Secure the working end (ie, the end that is inserted into the body) of the telescope or cord on a moist towel or away from any drapes, sponges, or other flammable

AORN Standards and Recommended Practices also stipulates in "Safe Environment of Care, Recommendation IX.b.4. The ends of an active fiber-optic light cable should not come in contact with surgical drapes. Fiber-optic light cables provide an ignition source if they are disconnected from the working element or light source and allowed to contact drapes, sponges, or other fuel sources. IX.b.5. Light cables should be connected before activating the light source. IX.b.6. The light source should be placed into a stand-by mode when not in use to prevent ignition. Backing into the light source or turning the fiberoptic light cable toward the body may cause surgical attire to ignite. IX.c. Personnel should move any equipment that emits smoke at any time, whether in use or not to a safe area. IX.d.7. Gowns and drapes should not be exposed to ignition sources."

2. According to hospital documents, the patient chart, and personnel interviews, at the conclusion of a shoulder arthroscopy case, Staff F a certified surgical technician (CST) noticed a burn hole in the drapes and blanket covering Patient #1, Staff F then checked the patient and noted a small reddened area less than a centimeter in size with a pin point brownish center. Further documentation indicates Dr. N was notified and instructed the nurse to apply "Bacitracin and a bandaid". Discharge instructions stipulate "antibiotic ointment and bandaid R (right upper thigh burn). Keep clean and dry. In an interview with Staff D the circulator present during the case, the light handle of the arthroscopy equipment had been placed on the drape covering the patient. Staff Dalso told surveyors Staff K was instructed to remove the equipment from use and send to be checked out.

3. According to the policy entitled "Documentation of Intraoperative Nursing Care" page 8 "Discharge Assessment"1. The condition of thepatient's skin on discharge is described. The drawing of the human form on the back of the first page of the record may be used to indicate the location of any change in the skin condition, i.e. abrasions, ecchymosis, lacerations, skin disorders, etc. There was no documentation of the "small reddened area" on the intraoperative documents.

4. The above findings were addressed in the exit conference 4/5/2012.