HospitalInspections.org

Based on observation and interview, the facility staff failed to dispose of expired medical supplies in the emergency department. This deficient practice has the potential to affect patients seeking treatment in the emergency department.
Findings include:

During an observation on 3/11/15 at 7:30 a.m. in the emergency department, the following medical supplies were expired and available for use:
-three packages of nitrate gloves which expired on 12/2014;
-a box of chronic gut sutures which expired on 1/2015;
- four gold BD Vacutainers which expired on 2/2015;
-three blue BD Vacutainers which expired on 1/2015; and
-one marble BD Vacutainer which expired on 1/2015.

In an interview on 3/11/15 at 7:30 a.m., staff member A, DON, stated all supplies should be checked for expiration dates monthly. She stated expired supplies were to be removed and not used.

Based on interview, the facility medical doctors failed to periodically review patient records with the physician assistant and/or nurse practitioner staff members. This practice has the potential to affect patients receiving care at the facility.
Findings include:

On 3/11/15 at 1:00 p.m., a list of medical records which had been reviewed by a medical doctor, in conjunction with mid-level providers, was requested from the medical record department. A list was not provided by the end of the survey.

In an interview on 3/11/15 at 2:15 p.m., staff member D, medical records manager, stated medical doctors do not review patient records with the mid-level providers. Staff member D stated she was unaware mid-levels needed to be included in the review of medical charts.

Based on observation and interview, the facility staff failed to date a multi-dose medication vial, and remove an expired medication from the emergency department. This deficient practice has the potential to affect patients seeking medical care in the emergency department.
Findings include:

During an observation on 3/10/15 at 1:30 p.m., with staff member A, DON, the emergency department had a multi-dose bottle of Epinephrine Lidocaine HCI 1 %. The vial did not reflect an open date and was available for use. In the medication cart, there was a box of Sodium Bicarbonate 50meq which had expired 2/2015.

In an interview on 3/10/15 at 1:30 p.m., staff member A, DON, stated all multi-dose medications should be dated as to when they were opened, and expired medications should be discarded from the department.

Based on record review and interview, the facility staff failed to develop a care plan for one (#6) of three inpatients. The facility staff failed to develop a care plan addressing post-discharge needs for two (#s 4 and 5) of three inpatient records.
Findings include:

Review of patient #4's inpatient record showed discharge planning was not assessed or captured on the care plan.

Review of patient #5's inpatient record showed discharge planning was not assessed or captured on the care plan.

Review of patient #6's inpatient record showed a care plan was not developed.

In an interview on 3/11/15 at 10:30 a.m., staff member A, DON, stated care plans should be developed immediately. The care plan should include discharge planning.

32998


Based on record review, the facility failed to develop a comprehensive care plan for 3 (#s 22, 24, and 25) of 9 sampled swing bed patients to include diabetic management and psychoactive medications. The facility failed to identify timetables for outcomes and assigned disciplines for interventions for 9 (#s 20, 21, 22, 23, 24, 25, 26, 27, and 28) of 9 sampled swing bed patients. Findings include:

1. Review of patient #20's care plan did not reflect timetables for outcomes or assigned disciplines for interventions.

2. Review of patient #21's care plan did not reflect timetables for outcomes or assigned disciplines for interventions.

3. Review of patient #22's active problem list reflected diabetes mellitus.

Review of patient #22's medication list reflected daily administration of insulin.

Review of the care plan for patient #22 did not reflect timetables for outcomes or interventions with assigned disciplines for diabetic management. The care plan did not reflect timetables for outcomes or assigned disciplines for interventions.

4. Review of patient #23's care plan did not reflect timetables for outcomes or assigned disciplines for interventions.

5. Review of patient #24's active problem list reflected asthma, obesity, anxiety and depression.

Review of the patient's current medication list reflected lorazepam, paroxetine, and Zoloft.

Review of the care plan for patient #24 did not reflect outcomes or interventions for antidepressant use and/or monitoring. The care plan did not reflect timetables for outcomes or assigned disciplines for interventions.

6. Review of patient #25's care plan did not reflect timetables for outcomes or assigned disciplines for interventions. The care plan did not reflect diabetic management outcomes or interventions.

7. Review of patient #26's care plan did not reflect timetables for outcomes or assigned disciplines for interventions.

8. Review of patient #27's care plan did not reflect timetables for outcomes or assigned disciplines for interventions.

9. Review of patient #28's care plan did not reflect timetables for outcomes or assigned disciplines for interventions.

Review of the facility policy for Care Planning reflected the following:
"...the care plan shall be individualized, based on the diagnosis, patient/resident assessment and personal goals of the patient/resident and his/her family, the planning for care, treatment and services will include the following: team member responsible for care, services and treatment, individualized to the needs of the patient/resident and evaluated at 90-day intervals or more frequently..."