HospitalInspections.org

Based on observation and interview the facility failed to ensure cracked and damaged flooring in the Emergency Department (ED) and patient rooms was repaired; wall trim was not pulling away from the wall in patient rooms; and flooring was maintained in a manner to keep it free of stains. This failed practice placed patients at risk for infection from ineffectively cleaned floors and/or injury from tripping. Findings:

Random observations from 3/2-5/14 revealed: 1) linoleum type flooring in the ED examination bays and the elevator was cracked and damaged around the edges of the rooms; 2) patient rooms 268, 272, and 275 had cracked flooring; 3) patient rooms 267 and 271 had trim pulling away from the wall; and 4) outside the Radiology Department door the linoleum type flooring was darkened with several stains.

During an interview on 3/4/14 at 11:30 am, when asked about the cracked flooring and the sagging trim in the rooms, Plant Manager confirmed some of the facility flooring was damaged and needed to be replaced due to aging.

During an interview on 3/5/14 at 9:10 am, when asked how they cleaned the cracked flooring, Environmental Services Staff (ESS) stated they just spray some sanitizing solution into the cracks. When asked about the soiled area in front of the Radiology Department door, ESS stated the buildup of the wax required stripping by hand and was cleaned as needed. At 9:30 am, the ESS confirmed there was no policy for cleaning or maintaining the floors.




.

Based on observation and record review the facility failed to ensure expired medications and biologicals stored in the Emergency Department, operating room, and the outpatient clinic were disposed of properly. As a result, patients were at potential risk for adverse effects from out-of-date medications and biologicals. Findings:

Observations in the Emergency Department from 3/2-5/14 revealed:

3 packages of adult Quinton Quick Prep Electrodes, used by date January 2013;

10 Intravenous (IV) bags of 0.9% sodium chloride (normal saline) 500 ml expired February 2014;

1 Siemens Multistix Reagent Strips for Urinalysis expired February 2014;

1 box of BD Blunt Plastic Cannulas expired November 2013;

1 box of BD Vial Access Cannulas expired November 2013;

1 Avagard D hand sanitizer 16 oz, expired June 2009; and

Alcohol wipes, expired January 2014.

During an observation on 3/3/14 at 9:45 am, in the operating room, revealed 4 bottles of Isopropyl Rubbing Alcohol 16 oz, expired February 2014.


Observation in the outpatient clinic drug room on 3/3/14 at 1:30 pm revealed:

1 EpiPen (emergency treatment of severe allergic reactions to insect stings or bites, foods, drugs, and other allergens; also for anaphylaxis of unknown cause) 2 pk, expired October 2013;

9 doses of Rantidine (a medication used to treat heartburn), expired October 2013;

5 unopened boxes of Senokot S (laxative), expired February 2013; and

1 box Ayr saline nasal gel, expired, which Licensed Nurse #1 confirmed was expired.

Review of the facility's policy "Medication Inventory Management", revised 3/31/11, revealed "A consistent comprehensive process will assure that medications are current in date and stocked as needed throughout the facility ...Responsibility for control of floor stock medications within this hospital rests with the Pharmacy Department ..."



.

Based on record review and interview the facility failed to ensure all of their pharmacy policies and procedures were reviewed on an annual basis. Findings:

Review of the Petersburg Medical Center Pharmacy Policy and Procedure binder on 3/5/14, revealed not all the policies had been reviewed on an annual basis to ensure the policies and procedures were being implemented and to determine if the policies needed revision.

Review of the Pharmacy Service Committee policy, effective, 5/25/01, revealed "The duties of the committee include. . . 3. Review and update all policies annually."

During an interview on 3/5/14 at 2:00 pm, the Chief Nursing Officer confirmed the binder contained the most current facility pharmacy policies.



.

Based on record review and interview the facility failed to ensure the following medical records were completed: 1) 1 transfer form for patient #13; 2) 1 physician order sheet for patient #13; and 3) 2 physician verbal orders were authenticated within 3 days for patient # 7, out of 22 patients whose medical records were reviewed. Findings:

Medical record review from 3/4-5/14 revealed Patient #13 was admitted 9/12/13 to the Observation Unit, through the Emergency Department (ED), and transferred to Bartlett Hospital in Juneau. Closed record review revealed the ED Physician order sheet was not signed by the physician. Further review revealed the transfer form, for transferring the patient to Bartlett Hospital, "PHYSICIAN CERTIFICATION" was not signed, dated, or timed by the physician.

Medical record review from 3/4-5/14 revealed Patient #7 was admitted to the facility 11/14/13. The closed record review revealed the physician had a verbal order, on 11/17/13, for "Albuterol 0.08% 2.5 mg [used to treat asthma and other similar lung problems] PRN [as needed] every 4 hours". The medical record revealed the physician signed the verbal order on 12/2/13.

During an interview on 3/4/14 at 4:30 pm, the Chief Nursing Officer confirmed the physician should have signed the transfer form and the physician order sheet for Patient #13. In addition she also confirmed the verbal order for Patient #7 that was signed on 12/2/13 was late.

Review of the facility's policy "Telephone and Verbal Orders" revised date 3/2010, revealed "...The ordering physician should sign the chart within 24 hours or as soon as possible."



.