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Based on record review and interview, the facility failed to ensure that 3 of 10 sampled patients (Patient ID # 7, 9, 10) had been provided a complete and accurate informed consent prior to surgery.

Findings include:

TX # 00172402

Patient ID # 7

Record review on 02-27-13 with of Patient ID # 7 ' s clinical record revealed he was a 74 year old male who was admitted to the facility on 07-10-12. Review of the Operative Report, dated 07-11-12 revealed Patient ID # 7 underwent a left shoulder hemiarthroplasty, implant removal and open reduction internal fixation of humeral component (with readjustment of the fracture plate and screws).

Review of the " Disclosure and Consent " form for Patient ID # 7, dated 07-11-12 listed the following under the space provided for the procedure: " hemi long stem arthroplasty and removal of deep implant. " The listed procedure did not specify right or left side of the patient ' s body.

Further review of Patient # 7 ' s consent page 2 of 6 read: " List A: procedure requiring full disclosure. ... (12) Arthroscopy of all joints with mechanical device ... (B) Mechanical internal; prosthetic device ... (B) Open reduction with internal fixation .... " The risks associated with this surgery were not initialed by the patient as part of the consent.

Patient ID # 9

Record review on 02-27-13 of Patient ID # 9 ' s clinical record revealed she was admitted to the facility on 07-13-12 and underwent a right knee arthroscopy.. Further review of Patient # 9 ' s consent page 2 of 6 read: " List A: procedure requiring full disclosure. ... (12) Arthroscopy of all joints with mechanical device ... " The risks associated with this surgery were not initialed by the patient as part of the consent.

Patient ID # 10

Record review on 02-27-13 of Patient ID #10 ' s clinical record revealed she was admitted to the facility on 07-11-12 and underwent a right reverse shoulder total arthroscopy.

Review of the " Disclosure and Consent " form for Patient ID # 10, dated 07-11-12 listed an inaccurate description of the procedure as follows: " right total reversal total shoulder. "

Interview on 02-27-13 at 3:30 p.m. with the Director of Heath Information Management (HIM) Staff # 7 she acknowledged the risks of the procedures should have been initialed for Patient ' s 7, # 9 and that the sections listing the procedures were not complete /accurate for Patients 9, # 10.

Review of facility policy titled " Disclosure and Consent For Medical and Surgical Procedures, " revised date 06/11, read: " 1. Patients who are anticipating a non-emergency medical or surgical procedure(s) identified on List A (full disclosure required). Consents for List A procedures will be prepared to include the specific risks identified by the Texas Medical Disclosure Panel., and those risks shall be imprinted on the form in the space provided ... "

Based on observation, interview, and record review, the facility failed to ensure that 14 of 14 patients (Patient ID#s: 1 ,2 ,3, 4, 5, 6, 11, 12, 13, 14, 15, 16, 17,18) received care in a safe setting. Supplemental oxygen cylinders were improperly stored in the Intensive Care Unit (ICU).

Improper storage of oxygen cylinders placed 13 patients at greater risk of the spread of an existing fire.

Findings include:

TX # 00172402

Observation on 02-27-13 at 9:55 a.m. during initial tour of the ICU revealed six (6) improperly stored oxygen cylinders in the supply room. Three (3) oxygen cylinders were observed lying horizontally, unsecured on the bottom shelf of a cart. Three (3) additional cylinders were observed lying horizontally, unsecured, and stored directly on the floor. Further observation revealed an oxygen storage cart located in the room, with several unfilled spaces for cylinders.

Interview on 02-27-13 at the time of observation with RN # 3, Charge Nurse, he stated the oxygen cylinders should be chained or stored in the oxygen storage rack. He stated he would have them removed immediately.

Record review of the ICU daily census dated 02-27-13 revealed there were 14 current patients admitted to the unit.

Review of facility policy titled " Procurement, Handling, Storage of Therapeutic Gases, " revised date 02/05, read: " 3. Select departments retain a small number of E cylinders for use, no more than twelve...storage: a;; freestanding cylinders in the bulk storage area must be chained ...Caution should be taken when handling all therapeutic gas cylinders, Cylinders should never be left upright and unsecured ...Oxygen cylinders must be placed in their carts, with stands upright during transportation. "

National Fire Protection Association (NFPA) Standards 99 Health Care Facilities (2005 edition): a total of up to 300 ft.? of oxygen may be stored per smoke compartment in any room or alcove without special requirements for that room; Cylinders must be secured in racks or by chains.