HospitalInspections.org

The Critical Access Hospital (CAH) reported a census of four patients, one acute patient and three swing bed patients. Based on observation and staff interview, the CAH failed to ensure all food preparation and handling surfaces are clean and orderly.

Findings include:

- The dietary kitchen, observed on 8/22/14 at 2:20pm, revealed three metal bins and three metal shelves in the cooks area, three metal drawers and a metal cabinet in the serving area, and seven metal cabinet legs in the serving and dishwashing areas with missing and chipped paint.

Dietary staff C, interviewed on 4/24/12 at 3:25pm acknowledged the chipped and missing paint of the metal cabinet shelves, bins and legs rendering the surface non-cleanable.

The CAH failed to ensure surfaces in the food preparation area are maintained and cleanable.

The Critical Assess Hospital (CAH) reported a census of four patients, one acute patient and three swing bed patients. Based on medical record review, Medical Staff Bylaws review and staff interview the CAH failed to ensure a complete history and physical were in the patients chart as required by the CAH's Medical Staff Bylaws for seven of seventeen sampled inpatients requiring a history and physical (patient #'s 11, 15, 19, 20, 23, 25, and 27). The CAH failed to ensure a complete history and physical were in the patients chart as required by the CAH's policy for outpatient surgery for two of three sampled outpatient surgical patients requiring a history and physical (patient #'s 28 and 29). This deficient practice had the potential to affect the patient's planned course of care.
Findings include:

- The CAH's Medical Staff Bylaws reviewed on 8/26/14 at 1:45pm directed, "...No patient shall be admitted to the hospital unless a physical examination and medical history are performed with regard to such patient within 48 hours after admission..."

- Patient #11's medical record reviewed on 8/25/14 revealed an admission date of 8/19/14 with a diagnosis of sepsis (an infection through out the body). The medical record contained a history and physical on patient #11 for 11/08/13 not a current history and physical for this admission.

- Patient #15's closed medical record reviewed on 8/25/14 revealed an admission date of 3/24/14 and discharged on 3/25/14 with a diagnosis of chest pain. The medical record contained a history and physical transcribed on 4/28/14 (34 days after admission).

- Patient #19's closed medical record reviewed on 8/25/14 revealed an admission date of 6/9/14 and discharged on 6/12/14 with a diagnosis of severe sepsis. The medical record contained a history and physical transcribed on 7/13/14 (31 days after admission).

- Patient #20's closed medical record reviewed on 8/25/14 revealed an admission date of 7/18/14 and discharged on 7/20/14 with a diagnosis of right abdominal pain. The medical record contained a history and physical transcribed on 8/4/14 (18 days after admission).

- Patient #23's medical record reviewed on 8/20/14 revealed an admission date of 8/9/14 with a diagnosis of pneumonia. The medical record contained a history and physical on patient #23 for 3/24/14 not a current history and physical for this admission.

Patient #25's medical record reviewed on 8/20/14 revealed an admission date of 8/3/14 with a diagnosis of Chronic Obstructive Pulmonary Disease (a lung disorder). The medical record contained a history and physical on patient #25 for 6/16/14 not a current history and physical for this admission.

- Patient #27's closed medical record reviewed on 8/25/14 revealed an admission date of 3/22/14 and discharged on 4/13/14 with a diagnosis of post sigmoid colectomy (a bowel surgery). The medical record contained a history and physical transcribed on 4/21/14 (30 days after admission).

Medical Records staff J interviewed on 8/26/14 at 10:30am, acknowledged the CAH failed to complete the patient's history and physical within the CAH's bylaws and rules within 24 hours of admission.

- The CAH's policy for Outpatient Surgery Documentation reviewed on 8/27/14 at 3:30pm directed, "...The history and physical and preoperative surgeon's note may be performed any time up to thirty days prior to the date of the procedure...A note on the day of the procedure from the surgeon...should be present..."

- Patient #28's closed outpatient surgical medical record reviewed on 8/26/14 revealed an admission date of 5/28/14 for a removal of a foreign body abdominal wall. The medical record contained a history and physical transcribed on 7/18/13 (10 months old).

Patient #29's closed outpatient surgical medical record reviewed on 8/26/14 revealed an admission date of 3/12/14 for a removal of a foreign body abdominal wall. The medical record contained a history and physical transcribed on 7/26/11 (more than two years old).

Operating Room Nurse staff I acknowledged the history and physicals on patient #28 and #29 failed to meet the CAH's policy for outpatient surgery history and physical.

The Critical Access Hospital (CAH) reported a census of four patients, one acute patient and three swing bed patients. Based on observation, policy review, manufacturer's guidelines, and staff interviews the infection control officer failed to develop an active and comprehensive infection control system which identified and investigated concerns for one of one hydroculator cleaning schedule and one of one terminal cleaning of the operating room.

Findings include:

- The CAH's job description reviewed on 8/27/14 at 4:35pm for the Infection Control Officer directed "...will be responsible for coordinating all infection prevention activities, data collection, evaluation of data related to infection surveillance, prevention and management..."

- Infection Control Officer staff D interviewed on 8/26/14 at 2:30pm verified they were responsible for the management of the infection control program. Staff D acknowledged they had not conducted surveillance for environmental cleaning practices observing breaches in infection control.

- Manufacturers maintenance instructions reviewed on 8/28/14 at 10:10am directed, "...The tank should be drained and cleaned periodically (usually every few weeks)..."

- Observation of the Physical Therapy Department on 8/21/14 at 9:40am revealed a Hydroculator (a tank with warm water in it to warm special hot packs used on patients with sore muscles). A log labeled "Cleaning Check Sheet for Hydraculator" on the wall above the Hydroculator revealed a monthly schedule for the cleaning of the Hydroculator. The schedule indicated the Hydroculator was cleaned on 1/28/14, 3/11/14 and 4/17/14.

Physical Therapy staff E, interviewed on 8/21/14 at 9:40am indicated the Hydroculator required a monthly cleaning and acknowledged staff failed to clean the Hydroculator monthly.

The CAH failed to have a policy directing staff on the cleaning of the Hydrocular.

- The manufacturer's guidelines for "Virex 256" disinfectant cleaner reviewed on 8/26/14 at 9:20am directed, " ...To disinfect ... hard, non-porous environmental surfaces ...all surfaces must remain wet for 10 minutes..."

- The Manufacturer's guidelines for "Stride Citrus" indicated the product was a non-alkaline general purpose cleaner and contained no disinfectant properties.

- The Association of Operating Room Nurses (AORN) 2013 edition recommendation for environmental cleaning reviewed on 8/27/14 at 12:30pm directed, "...Floor should be wet-vacuumed with an EPA-registered disinfectant..."

- Operating room staff G, staff H, and staff I observed on 8/27/14 between 11:40am and 12:20pm cleaned the operating room of the surgical suite. Observation revealed the following breaches in infection control practices regarding disinfectant wet time per manufacturer's recommendation for total disinfection. For example:

Staff G, staff H and staff I using "Virex 256" cleaner cleaned the back-up table, basin holder, step stool, patient table and cover, arm boards, trash cans, prep table, Anesthetic machine, cautery machine, and lights. The surfaces remained wet between two to nine minutes. The surfaces failed to remain wet for the required 10 minutes for total disinfection.

Staff I using "Stride Citrus" cleaner mopped the operating room floor.

Staff G, staff H and staff I interviewed on 8/27/14 at 12:35pm acknowledged the surfaces failed to remain wet the required 10 minutes for total disinfection, and they failed to use a disinfecting product on the floor when conducting a terminal clean of the operating room.

The Critical Access Hospital (CAH) reported a census of four patients, one acute patient and three swing bed patients. Based on medical record review, policy review and staff interview the CAH failed to ensure providers date/and or time all authenticated (signed) entries in the medical record for four of twenty sampled medical records reviewed (patient #'s 15, 18, 26, and 27).

Findings include:

- The CAH's policy titled, "Entry into the Medical Record" reviewed on 8/26/14 at 1:45pm directs, "...Each entry into the medical record is to be legible, timed, dated and authenticated..."

- Patient #15's closed medical record reviewed on 8/25/14 revealed an admission date of 3/24/14 and discharged on 3/25/14 with a diagnosis of chest pain. Patient #15's medical record revealed between 3/24/14 to 3/25/14, three telephone/verbal orders lacked a date and time when co-signed by the provider.

- Patient #18's closed medical record reviewed on 8/25/14 revealed an admission date of 5/6/14 and discharged on 5/9/14 with diagnoses of sepsis (infection in the body). Patient #18's medical record revealed between 5/6/14 to 5/9/14, three telephone/and or verbal orders lacked a date and time when co-signed by the provider.

- Patient #26's closed medical record reviewed on 8/25/14 revealed an admission date of 6/11/14 and discharged on 7/7/14 with diagnosis of second degree burns. Patient #26's medical record revealed between 6/11/14 to 6/12/14 six telephone and/or verbal orders lacked a date and time when co-signed by the provider.

- Patient #27's closed medical record reviewed on 8/25/14 revealed an admission date of 3/29/14 and discharged on 4/13/14 with diagnosis of post sigmoid colectomy (a bowel surgery). Patient #27's medical record revealed between 4/3/14 to 4/13/14 three telephone and/or verbal orders lacked a date and time when co-signed by the provider.

Medical Records staff J, interviewed on 8/26/14 at 10:30am acknowledged at times the medical records lacked the date and time when co-signed by providers.