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Based on observations and interviews with key staff on July 27 and 28, 2010, it was determined that the facility failed to ensure that all patient care services were furnished in accordance with the applicable State Regulation stated in the Rules for the Licensing of Hospitals, 10-144 Chapter 112, Section 3.1, Standards: Patient Rights in Critical Access Hospitals. A critical access hospital must protect patient rights and comply with the conditions for patient rights contained in 42 C.F.R. ?482.13(c)(1), which requires that the patient has the right to personal privacy.

Findings include:

1. On July 27, 2010 at 4:10 p.m., a surveyor observed a computer, in an examination room in Trenton Health Center, an Outpatient Department of Mount Desert Island Hospital, and the computer screen displayed patient names. The computer was unattended.

2. Interviews with the Office Manager and the Clinical Supervisor on July 27, 2010, confirmed that staff from other sections of the facility do walk by the examination room and could also view the patient names. Additionally, patients being seen by the Behavioral Health staff also could view the names when walking by the computer.

Based on observations and interviews with the Nursing Coordinator on July 28, 2010, it was determined that nursing services failed to meet all the needs of patients.

Findings include:

1. On July 28, 2010 at 0930 during an observation of medication administration revealed that the Registered Nurse (RN) failed to follow appropriate infection prevention procedures by placing a medication cup, handled by the patient, onto the medication cart without disinfecting the medication cart after this patient use and before the cart was used for other patients.

2. On July 28, 2010 at 0940 during an observation of a wound dressing change, the RN failed to follow aseptic technique by placing the undressed leg wound directly on the bed sheets. In addition, the RN touched the bed controls with the clean gloved hand and proceeded to complete the dressing change with the then contaminated gloved hand.

Based on a review of anesthesia policies, review of anesthesia forms and interviews with the Lead Certified Registered Nurse Anesthetist (CRNA) on July 25, 2010, it was determined that there was no documented evience that CRNA ' s at the hospital were under the supervision of the operating practitioner.

Findings include:


1. During an interview on July 28, 2010, the Lead CRNA described the anesthesia forms as having two sides - the first side contained the anesthesia plan and the reverse side contained the anesthesia record.The Lead CRNA stated that the anesthesia plan was completed by the CRNA prior to surgery, and signed by the surgeon.

2. The State of Maine Board of Nursing Rules and Regulations Chapter 8, C, (3) states: " adjustments and corrective actions as indicated. For aspects of anesthesia practice that require execution of the medical regimen, the certified registered nurse anesthetist shall be responsible and accountable to a physician or dentist. Without limitation, coordination and appropriate communication shall be deemed to have occurred if the prescribing physician or dentist shall have signed the patient's anesthesia record."

3. The Lead CRNA further described the anesthesia plan as a general description of the technique to be used, such as, " general anesthesia, or regional block", but did not necessarily contain the medications or doses to be used during the surgery. It also did not list adjunct medications to be used, nor did it list medications, doses or route of administration that may have been administered in the operating room that were not originally part of the plan.

4. The Lead CRNA confirmed that the anesthesia record was completed by the CRNA in the operating room during the procedure. The medications administered during the operative procedure, their dose, route of administration, and any adjuncts used, were recorded on the anesthesia record.

5. The Lead CRNA furhter confirmed that there was no documentation of physician authentication on the anesthesia record.