HospitalInspections.org

Based on medical record review and interview, in 2 of 6 reviewed cases the hospital failed to inform each patient, or when appropriate, the patient's representative (as allowed under State law), of the patient's rights, in advance of furnishing or discontinuing patient care whenever possible. Findings include:

During review of the medical record for patient #17 on 5 North , it was noted that the record did not contain the "Important Message" from medicare. This was confirmed by the 5 North Unit Manager at time of record review. Patient #18's medical record on 5 South also did not contain the "Important Message" from Medicare. This was confirmed by the 5 South Unit manager.

Based on medical record review, it was determined that the hospital failed to ensure that an admitted patient was asked whether s/he wanted a family member or her/his physician notified of the patient's admission in order to make them aware of the patient's admission to the hospital. Findings include:

<1> In 11 of 13 reviewed medical record of patients admitted to the hospital through the hospital's emergency room, review revealed that documentation did not substantiate that the admitted patient was asked whether s/he wanted a family member to be notified of her/his admission (patient #28, #36, #51, #53, #54, #56, #59, #60 #68, #69, and #70).

In 6 of the above 11 non-compliant reviewed medical records, while documentation indicated that the patient was accompanied to the hospital's emergency department by a family member or friend (one could not tell whether the patient was accompanied by a family member or friend), the medical record did not substantiate that the admitted patient was asked whether s/he wanted a family member not in attendance to be notified of her/his admission (patient # 51, #53, #56, #59, #60, and #70)

<2> In 12 of 13 reviewed medical records of patients admitted to the hospital through the hospital's emergency room, review revealed that documentation did not substantiate that the admitted patient was asked whether s/he wanted her/his physician notified of her/his admission (patient #28, #36, #50, #51, #53, #55, #56, #59, #60 #68, #69, and #70).

<3> In 1 of 1 cases involving a patient's direct admission (patient was not screened in the hospital's emergency department) to a nursing unit, medical record review revealed that documentation did not substantiate that patient #71 was asked whether she wanted a family member or her physician notified of her admission.

Based on observation and interview, it was determined that the facility failed to properly protect the privacy of patients. Findings include:

During the tour of the ICU unit and Oncology department on 4/19/10, it was observed that the patient's last name was posted outside the patient's room and was accessible for public viewing. When queried about patient privacy the Chief Nursing Officer indicated that "The facility has always done it like that".


18299

During observation of the 2 North and 2 South telemetry/cardiac stepdown units on 04/19/2010, it was noted patient last names were posted on the walls outside their respective rooms.


28273

During observation of the 5 North and 5 South medical/surgical areas on 04/19/2010, it was noted that patient names were posted on the walls outside of the rooms.


13155

During observations on the rehabilitation unit (3S) and oncology unit (3N) on 4/12/10 it was observed that patient last names were posted on entryways to patient bedrooms.

Based on record review and interview the facility failed to keep current care plans for patients for 2 of 2 records reviewed. The findings include:

During review of open medical records on 04/20 /2010 at 1015 , patient's #28 & #35 care plans lacked the authentication by a Registered nurse.

It was confirmed by the Chief Nursing Officer on 04/20/2010 at the Nursing Services meeting held at 1300 that a Registered Nurse did not authenticate the care plans.


28273

Based on record review and interview the facility failed to keep current care plans for patients for 2 of 12 records reviewed. Findings include:

During review of open medical records on 04/19 2010 on 5 North & 5 South, patient #18's care plan lacked documentation regarding the patient being on contact precautions for Klebsiella pneumoniae. This was confirmed by the 5 South Unit Manager on 04/19/2010 at 1130. Patient # 17's care plan lacked documentation regarding the patient being on contact precautions for C-diff. This was confirmed by the 5 North Unit Manager at 1300.

Based on record review and interview, the facility failed to ensure that all patient medical record entries were completed with the physician signatures, nursing signatures and the correct date and time, in 11 of 20 clinical records reviewed. Findings include:

During record review on 4/19/10 - 4/21/10 it was noted that pre-op orders, pre-anesthesia testing orders, physician ' s orders, post-anesthesia records, and surgical discharge orders and care plans in medical records for patient's # 28, #29, #33, #34, #35, #36, #37, #38, #39, #40 and #41 were incomplete for physician signatures, nursing signatures, dates and time.

Based on open and closed record review and interview, the facility failed to ensure that all verbal orders taken by the physician were authenticated within the 48 hour time frame. Findings include:

Clinical record review on 04/21/2010 at 1050 revealed that staff had taken a telephone order for patient #35 on 03/21/10 at 1700 for medication, including Morphine 5mg IV.

Clinical record review on 04/21/2010 at 1100 revealed that staff had taken a telephone order for patient #37 on 03/17/10 at 2000 for medication and care plan, including Ativan 1 mg IVP (inter-venous push); Morphine Sulfate titrate for comfort, Atropine .4mg every 4 hours for congestion and admit to hospice.

Neither of the orders had been authenticated (signed) by a physician within the 48 hour time frame.


28273

Clinical record revealed on 04/19/2010 at 1300, revealed that staff had taken a telephone orders for patient #16 on 04/16/10 at 1710 and 2200. The 1710 order was for Coumadin 2.5mg tonight and the 2200 order was for Metamucil 2 tablespoons x 1. The orders had not been authenticated (signed) by a physician within the 48 hour time frame.

Based on staff interview, and record review, it was determined the facility failed to ensure that all discharged inpatient's clinical records were complete, including an authenticated signature from the attending physician. Findings include:

During an interview and record review with the Director of Health Information Services on 4-21-10 at 11:00 am , it was determined there were 751 incomplete inpatient clinical records that were awaiting signatures from the physician 30 days following the patient's discharge from the hospital.

Based on observation and interview, it was determined that the facility failed to ensure that drugs and biologicals were kept in a locked/secured area. Findings include:

On 4/19/10 at approximately 10:50 am when entering the ICU (unit #1- closed area and unoccupied by both patients and staff members.), it was observed that the medication cupboard in this area was found to be unlocked and unattended.

During observation of the ICU (unit #1), the medication cupboard in this closed unit had 2 cupboards that were not locked. Upon review of the contents, the unsecured cupboards contained Sodium Bicarb, Dextrose, Lidocaine, Dopamine, Epinephrine, Oral Acetaminophen, Narcan, and Labatelol.

The Chief Nursing Officer and the ICU unit manager confirmed these findings on 4/19/10.


28273

Based on observation and interview the facility failed to ensure that drugs and biologicals were kept in a locked/secured area. Findings include:

During observation of 5 South, the medication cart labeled MC55B had 4 drawers that were not locked. Upon review of the contents, drawer #1 contained Insulin and Saline vials and drawer #3 contained needles and syringes. The other two drawers contained batteries and books. On the same unit, medication cart labeled MC5SA had one drawer that was not locked. This drawer contained needles and syringes. Interview with the 5 South Unit Manager confirmed that the entire cart was supposed to lock automatically after a 2 minute period. After the 2 minute wait period, these areas remained unlocked.

Based on observation and interview the facility failed to ensure outdated biologicals were not available for use. Findings include:

During the observation tour of the pre-op holding area on 4/21/10 at approximatley 0930 2 outdated insulin needles (October 2009) were noted to be in the opened insulin vial tray housed in the medication refrigerator.


27408

Based on observation and interview the facility failed to ensure outdated biologicals and supplies were not available for use. Findings include:

On tour of the ICU Unit (1 South) on 04/19/2010 at 1030 it was observed that on the Bronchoscopy Cart in the clean supply room, there were 2 tubes of Lidocaine that outdated on 8/2008 and one tube that outdated on 2/2009. There were also 4 specimen traps that outdated on 3/10 and 2 on 9/08. Interview with the manager on 04/19/10 at 1035 identified that this duty (monitoring of the Bronchoscopy cart) was performed by the Pharmacy, Central Services, & Nursing Department and no explanation was given as to why this task was not completed. The unmonitored supplies on the Bronchoscopy cart provided opportunity for patients to receive outdated and or otherwise unusable drugs and supplies.



28273

During observation of the pre-op area on 04/21/2010 at 1000, revealed that there were 3 vials of Lidocaine 1% and 1 vial of Versed that were not dated when opened. This was confirmed at time of observation by RN #2.

During observation in the PACU area on 04/21/2010 at approximately 1030, the refrigerator contained three boxes of Xopenex inhalation medication used for nebulizer treatments. Instructions for storage on the package label read "should be stored between 68 and 77 degrees F". This was confirmed at 1035 by the Director of Surgical Services. Interview with Pharmacist #1 on 04/22/2010 at 1240, she stated that the medication should not be stored in the refrigerator.

During observation of the Respiratory Department on 04/22/2010 at 1000 with the Director of Respiratory Services, there were 5 containers of Xopenex medication used for Nebulizer treatments that were outdated. Four containers were outdated 6/09 and one container was outdated 5/04. This was confirmed at the time of observation by the department director.

The facility failed to provide and maintain a safe environment for patients and staff.

This is evidenced by the Life Safety Code deficiencies identified. See A-710.

Based upon on-site observation and document review by Life Safety Code (LSC) surveyors on April 19-21, 2010, the facility does not comply with the applicable provisions of the 2000 Edition of the Life Safety Code.

See the K-tags on the CMS-2567 dated April 21, 2010, for Life Safety Code.

Based on observation, equipment failed to be maintained to ensure an acceptable level of safety. Findings include:

During the observation tour of the surgery department on 4/21/10 at approximately 11:00am, it was noted a large sharps container sitting on a cart in the middle of the surgery satellite pharmacy with its one way safety lid opened and access to the contaminated sharps container unimpeded should someone accidentally put their hand in it.


27408

During the observation tour of 3 North / Oncology department on 4/19/10 at approximately 1200, it was noted that there was an unsecured cupboard that contained disposable surgical scalpels, and a box of each #11 & #15 surgical blades.

The Oncology manager and the Chief Nursing Officer confirmed these findings

Based on observations elements of the facility essential for safety were not provided:

1. The two rooms within histology located on 2 East lack proper access to handwashing facilities as required to ensure a safe work environment as observed on the morning of April 21st. The doors to these rooms are to remain closed to allow proper function of the ventilation systems to minimize staff exposures to infectious agents and the various hazardous chemicals being used,. With the doors closed, proper access to handwashing cannot be provided with the facilities as found.
2. The required brushes, personal protective equipment, fill lines, calibrated flasks, and manufacturers ' manuals were not found in the 1 West ambulatory surgical suite on the afternoon of April 20th or the 3 East main surgical suite on the morning of April 21st where surgical instruments are cleaned prior to flash sterilization as needed to ensure safe and proper reprocessing.
3. None of the exit doors from any of the inpatient, surgical recovery, and emergency air borne isolation rooms were found on the mornings of April 20th and 21st to be equipped with the required closers to ensure containment of infectious agents to protect staff and the public.
4. The vacuum style backflow device serving the autopsy table was found on the afternoon of April 21st to not be mounted at the minimum required 7 feet above the floor as needed to protect the potable water supply within the hospital.