HospitalInspections.org

Based on review of facility documentation, medical record (MR), and staff (EMP) interview, it was determined the facility failed to ensure the patient or his or her representative had the right to make informed decisions regarding his or her care for two of two applicable medical records reviewed (MR19 and MR20).

Findings include:

Review on April 4, 2022, of facility documentation "Geisinger Bloomsburg Hospital Guidelines for Medical Records," approved on July 7, 2020, revealed "...Permission and Consent for Surgery or Procedures The Permission and Consent for Surgery or Procedures is to be signed by the patient or the patient's legal representative prior to surgery or procedures. The exception to this is an emergency situation which based upon the health care provider's judgment, continued delay in treatment would increase the risk to the patient's life or health. ... "

Review on April 4, 2022, of the facility's "Permissions and Informed Consent Policy," last approved January 24, 2022, revealed "...Purpose Geisinger respects each patient's right to be informed of proposed surgical or medical interventions, as well as the patient's right to accept or refuse any such interventions. ...Except in emergency situations (see Section L below), permission and informed consent must be obtained from the patient or the patient's authorized representative and documented pursuant to this policy before proceeding with a proposed intervention listed in this Policy. ...D. What Types of Procedures Require Informed Consent at Geisinger? 1. Under Pennsylvania law, a physician owes a duty to the patient to obtain the informed consent of the patient or the patient's authorized representative prior to any provider undertaking the following: ... c. administering a blood transfusion; ..."

Review of MR19 on April 4, 2022, revealed MR19 was administered a blood transfusion of packed red blood cells on March 26, 2022. There was no informed consent for the administration of blood products in MR19.

Review of MR20 on April 4, 2022, revealed MR20 was administered blood products on March 8, 2022. The informed consent form was missing the MR20's initials accepting transfusion of blood or blood products.

Interview with EMP2 on April 4, 2022, at 1200 confirmed MR19 did not have an informed consent for blood transfusion and MR20's informed consent for blood transfusion was incomplete and did not contain MR20's initials accepting transfusion of blood or blood products.

Based on facility documents, medical record reviews and staff (EMP) interview, it was determined the facility failed to ensure medical records complete for three out of three Emergency Department SANE (Sexual Assault Nurse Examination) medical records reviewed (MR6, MR7 and MR8).

Findings include:

Review on April 5, 2022, at approximately 1510, of facility "Amended and Restarted Bylaws of the Medical Staff of Geisinger-Bloomsburg Hospital," last approved June 16, 2021, revealed "Section 3.3 Basic Responsibilities of Staff Membership ... (e) Prepare and complete in a timely manner all medical and other records pursuant to all applicable policies, procedures, standards, and rules and regulations of the Hospital and of the Medical Staff. ..."

Review on April 5 ,2022, at approximately 1500, of facility "Geisinger Bloomsburg Hospital Guidelines For Medical Records," last approved July 7, 2020, revealed "...Discharge Summary ...The content of the discharge summary must include ... condition on discharge, ..."

Review on April 4, 2022, of MR6, revealed MR6 was a 21-year-old female patient admitted to the Emergency Department (ED), on February 6, 2022, for sexual assault. No documentation noted MR6's condition at discharge.

Interview with EMP1, on April 4, 2022, at 1430, confirmed MR6 was a 21-year-old female patient admitted to the ED, on February 6, 2022, for sexual assault. EMP1 confirmed MR6 with no documentation of MR6's condition at discharge. EMP1 confirmed the medical record is to have documentation noting the patient's condition at discharge.

Review on April 4, 2022, of MR7, revealed MR7 was a 20-year-old female patient admitted to the ED, on January 29, 2022, for sexual assault. No documentation noted MR7's condition at discharge.

Interview with EMP1, on April 4, 2022, at 1440, confirmed MR7 was a 20-year-old female patient admitted to the ED, on January 29, 2022, for sexual assault. EMP1 confirmed MR7 with no documentation of MR7's condition at discharge. EMP1 confirmed the medical record is to have documentation noting the patient's condition at discharge.

Review on April 4, 2022, of MR8, revealed MR8 was a 23-year-old female patient admitted to the ED, on January 28, 2022, for sexual assault. No documentation noted MR8's condition at discharge.

Interview with EMP1, on April 4, 2022, at 1450, confirmed MR8 was a 23-year-old female patient admitted to the ED, on January 28, 2022, for sexual assault. EMP1 confirmed MR8 with no documentation of MR8's condition at discharge. EMP1 confirmed the medical record is to have documentation noting the patient's condition at discharge.

Based on review of facility documents, observation, and staff interview (EMP), it was determined the facility failed to ensure food for patient consumption was stored properly and was unexpired, appropriate dish washing temperatures were maintained, and all hair of staff was restrained in the dietary department.

Findings include:

A request was made to EMP2 facility for a policy on food storage on April 5, 2022. No policy was provided.

Review on April 6, 2022, of facility policy Labeling & Dating of Food, Foodservice," published on March 25, 2022, revealed "...Policy To ensure food items that are prepared, served, or stored correctly labeled and dated according to established guidelines. ...Procedure Please follow the guidelines listed on the attached document for correct labeling, dating ranges and correct style label. ... "

Review on April 6, 2022, of facility documentation "Geisinger Foodservice Labeling and Dating Guidelines," updated March 24, 2022, revealed "Labeling Guidelines All prepared or open food items must be labeled with the item name and expiration date...All prepared food items that are proportioned out individually (ex. Salads, fruit cups, desserts, etc) will be wrapped labeled and dated with a use by date of 1 day. The entire tray of items can be wrapped as one, or the items can be wrapped individually following the label and dating standards. ...Storeroom Dry storage items - Unopened Expiration 1 year or Mfr. Expir. Date Dry storage items-boxed & bagged - Once opened Expiration 6 months..."

Observation during a tour of the dietary department with EMP3 on April 6, 2022, at approximately 1000, revealed the following expired items in the dry food storage room: three bags of farro grain marked with an expiration date of January 12, 2020, one tub of individually wrapped cookies with a use by date of February 15, 2022, a jar of barbeque sauce with a use by date of April 5, 2022, and four expired cartons of liquid supplemental nourishment. The dry food storage room also contained the following bulk items with no expiration dates: approximately ten bags of farro grain, ten bags of split peas/garbanzo beans, ten bags of sunrise breakfast blend, ten bags of tortilla chips, four bags of pita chips, two bags of croutons, a tub of individually wrapped crackers, and a five-pound bag of yellow cornmeal. Bulk items that had been opened and were not tightly secured or placed in rigid containers to avoid contamination by moisture, vermin or insects included: a 25-pound bag of barley, a 25-pound bag of lentils, a large bag of panko breadcrumbs and two bags of pasta noodles. Observation in the main kitchen area revealed an open flour bin in the baking area and outdated cheeses, including four packages of single slice cheese with a use by date of March 15, 2022, in a portable cooler. Observation in cooler #1 revealed a large tray with desserts and three individual salads. Neither the individual portions or tray were wrapped and dated with an expiration date. Observation in cooler #4 revealed a container of gravy and a container of mashed potatoes with an expiration date of April 5, 2022.

Interview with EMP3 at the time of the tour confirmed the findings of expired items, the lack of expiration dates on food items and the improper storage of the cooler items.

Interview with EMP4 on April 6, 2022, at 1130, confirmed there was no policy to address the storage of food items. EMP4 revealed the expectation that open bulk food items should be placed in a sealed container, labeled, and dated with an expiration date.

Review on April 6, 2022, of facility log "Pot Room/Manual Warewashing Log" revealed the "Min - 110 degrees F Wash Sink Temp... Directions 1. Complete this form for each meal period...4. If water temperature is incorrect of chemical strip indicates improper strength, record corrective action taken..."

Review of the "Pot Room/Manual Warewashing" logs for August 2021 through February 2022 revealed the wash sink temperature was below the 110 degrees F minimum on August 12, 17, 18, 19 and 20, 2021, September 10, 11, 14, and 17, 2021, October 15 and 17, 2021, November 5, 2021, December 13, 15, 21, and 23, 2021, January 18 and 22, 2022, and February 14, 15, 16, 17, 18, 19, 20, 22, 24, 2022. There were no corrective actions noted anytime the temperatures were below the 110 degrees F minimum.

Interview with EMP2 on April 6, 2022, at approximately 1115, confirmed the temperatures for the wash sink on the dates above were below the required minimum. EMP2 further confirmed there were no corrective actions noted when the temperatures were below the required minimum.

Review on April 6, 2022, of facility policy "Uniforms/Cress Code, Foodservice," dated October 19, 2021, revealed "...Persons Affected Foodservice Workers, Patient Service Liaisons, Storeroom Clerks, Cooks, First Cooks, Leads, Catering, and Supervisors. Policy...Hair is to be covered per the requirements of PA Food Code 46.152: (a) General requirement. Employees shall wear hair restraints such as hats, hair covering or nets, beard restraints and clothing that covers body hair that are effectively designed and worn to keep their hair from contacting exposed food; clean equipment, utensils, and linens; and unwrapped single-service and single-use articles. ..."

Observation during tray line on April 6, 2022, at 1130 revealed a foods service worker with hair escaping from the hair restraint and a food service worker wearing a ball cap with an approximately eight-inch braid dangling out of the back of the cap. Both workers were handling patient food trays.

Interview with EMP7 at the time of the observation confirmed the hair of the food service workers was not properly restrained.

Based on review of facility policy and documentation, tour and observation, and staff (EMP) interview, it was determined the facility failed to maintain a clean and sanitary environment.

Findings include:

1) Review of facility, "Linen Policy," last reviewed on September 21, 2021, revealed "Purpose: The Infection Control Linen Policy establishes guidelines to ensure safe storage and handling of clean ... linen. ... e. Clean bulk linen is stored in the clean linen room on stainless steel wire shelves or other approved shelving that has a solid bottom shelf to prevent contamination. ..."

Tour and observation of the medical/surgical unit on April 5, 2022, at approximately 0925, revealed storage of one bag of "clean" bagged linens in the linen closet stored directly on the floor.

Interview with EMP5 on April 5, 2022, at approximately 0925, confirmed the "clean" linen storage directly on the floor.

2) Review of the "Environmental Services Scope of Services Policy," last approved January 31, 2022, revealed: "Services provided by the Environmental Services department include, but are not limited to: ... Floor care, to include stripping, waxing, buffing, and carpet extraction- scheduled and as needed..."
Tour and observation of the medical/surgical unit on April 5, 2022, at approximately 0930 revealed a dirty grey appearance of multiple irregular spots near the entryway of patient rooms along the north hall.
Interview with EMP5 on April 5, 2022, at 0935, confirmed the findings of floor spots and related that the hand antisepsis product was creating the spots on the floor.
Interview with EMP6 on April 5, 2022 at 1010 confirmed that the facility had noted the spots and felt it was the hand antisepsis product reacting with the wax on the floors. Further interview with EMP6 on April 5, 2022, related that the environmental services mops the floors daily inside patient rooms and scrubs/buffs the floors as needed. The surveyor asked how frequently the floor is routinely scheduled to be scrubbed/buffed and EMP6 stated they scheduled it on an as needed basis.
Review of facility documentation supplied by EMP6 on April 6, 2022, at 1405 revealed that the scrubbing/buffing was last completed on March 4, 2022.