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Based on review of facility documentation and medical records (MR), and employee interviews (EMP), it was determined that the facility failed to ensure that propofol sedation orders included a sedation level or desired level of sedation for two of two mechanically ventilated patients in the ICU (MR10 and MR11).

Findings include:

Review of the Grove City Medical Center Medical Staff Rules & Regulations, version: June 2016, revealed, "D. GENERAL CONDUCT OF CARE ... 3. The practitioner's orders must be written clearly, legibly, and completely."

Review of Grove City Medical Center Policy Stat ID: 2231706, revised April 2015 revealed, "Propofol Continuous Infusion in ICU ... POLICY STATEMENT: Propofol infusion is indicated for the sedation of a patient receiving mechanical ventilation in a critical care setting. ... A. General Information ... 2. The continuous infusion must be administered on an infusion pump using the pump formulary and the order must relate a therapeutic goal, i.e. sedation level, or explanation of the desired level of sedation."

1. Review of MR10 revealed a propofol sedation order dated August 22, 2016, at 6:00 AM. Further review of the order revealed no sedation level or explanation of the desired level of sedation.

On October 25, 2016, at 2:02 PM, when asked if the physician order for sedation (MR10) included a sedation level, EMP10 stated, "No. [He/She] did not. ... Now that we use the RASS (Richmond Agitation-Sedation Score) score, it's (sedation level) a negative two." EMP10 confirmed that the desired level of sedation of negative two is not typically included in the sedation orders.

2. Review of MR11 revealed a propofol sedation order dated August 28, 2016, at 12:30 AM. Further review of the order revealed no sedation level or explanation of the desired level of sedation.

On October 25, 2016, at 2:25 PM, EMP10 confirmed there was no sedation level included on the order for sedation (MR11).

3. On October 27, 2016, at 10:30 AM, EMP38 confirmed that orders for sedation did not include the desired level of sedation stating, "... it's just a known thing."

Based on review of facility documentation, observation, and employee interviews (EMP), it was determined that the facility failed to maintain the cleanliness of the physical environment in the Dietary Department.

Findings include:

Review of the Grove City Medical Center Policy, "Procedure for Floor Cleaning 410," reviewed August 2015, revealed, "POLICY: The Nutrition Services Department is responsible for maintaining the cleanliness of the floors in the kitchen. The floor will be swept at least 3 times a day or more as needed. It will be scrubbed with the floor scrubber at least once a week."

1. Review of a document titled, "Cleaning List," no review/revise date, revealed, "Dishwashers and Volunteer: All edges where floor meets wall should be free of build up and debris. This means the entire perimeter of the kitchen-underneath the tilt skillets, fryers, etc. The floors are to be DECK BRUSHED and mopped. They should look brand new Monday morning upon my arrival. All underneath shelves in dish area need cleared off, washed, rinsed and sanitized. Cafeteria Staff: High dusting needs done in entire café. ... Clean underneath hot wells-take out all lids and wipe down well-no debris left. ... Cooks: Clean fryers very well. No debris in between or underneath. ..." At approximately 10:30 AM on October 28, 2016, EMP7 identified the origination date as May 2016.

2. Tour of the Dietary Department on October 27, 2016, from approximately 2:00 PM to 2:45 PM revealed debris and build-up on the floor perimeter throughout the food cooking and preparation area; between the fryers, ovens, and skillets; and around a freestanding heater and cooler. Build-up was further observed on a grated floor drain adjacent to the fryer. Debris was observed on the ice machine and food trays. Heavy dust was observed on the wall and lockers adjacent to an internal office. Dust was observed on the ceiling of Cooler #5 in front of the fan. A damaged drop-ceiling tile with exposed upper ceiling was further observed in the dry-storage room.

3. EMP39, present for the tour, confirmed the aforementioned findings after a review of the observations at 2:40 PM on October 27, 2016.

4. On October 28, 2016, at 9:45 AM, when asked for documentation for the use of a floor scrubber, EMP39 stated, "Done manually. Not with a scrubber."