HospitalInspections.org

Based on interview, review of medical record and other documents, it was determined that Nursing Services did not implement its policy to ensure prompt identification and treatment of pressure ulcers. This finding was noted in 1 of 5 records of patients with pressure ulcers (Patient #1).

Findings include:

Patient #1 is a 65-year-old male admitted to the facility on 1/8/15 in a coma with brain injury. CT scan of the head revealed large subarachnoid hemorrhage, subdural hemorrhage, and midline shift.

The initial nursing assessment on 1/18/15 identified the patient with impaired skin, and at a high risk for developing pressure ulcers evident by a Braden Score (clinical tool Predicting Pressure Sore Risk) of 11. There was no pressure ulcer present on admission; however, patient's tongue was cyanotic and purplish in color.

The facility's policy titled "Pressure Ulcer Management," last revised October 2013, notes nurses role and responsibilities include assessment of patient skin condition and nutritional intake on each 12 hour shift. In addition, nurses "on an ongoing basis, assess pressure ulcer prevention and treatment and the patient's response to therapy, such as change, or lack of change, from previously documented condition and the need for changes to the plan of care."

The daily nursing assessment failed to identify changes in the patient's skin condition and provide timely treatment in accordance with the facility's policy. Five of the seven pressure ulcers developed by the patient were identified in their late stage of development. A left elbow ulcer was first documented on 2/11/15 as an unstagable ulcer, 8 centimeters (cm) x 7 cm in dimension with foul purulent drainage. On 5/2/15, nursing staff identified four more unstagable, ulcers; a left ankle 3 cm x 2cm, a left ear ulcer 3 cm x 2.5 cm, left ischium ulcer, 7 cm x 4 cm and two sites on the head 4 cm x 2 cm each. There was no treatment documented for these pressure ulcers before they were documented on 2/11/15 and 5/2/15.

At interview with Staff #1, Wound Care Nurse on 8/24/15 at 9:30 AM, she stated the patient skin condition is assessed ever shift by nursing staff, changes in the skin condition is documented immediately and treatment initiated in accordance with facility's protocol. The staff acknowledged that patient's pressure ulcers were not timely identified and documented.

Based on observation and staff interviews, the facility did not maintain the physical environment in the Emergency Department in such a manner to assure the safety and well-being of patients.

Findings include:

During tour of the Emergency Department conducted on 8/20/15 at approximately 2:00 PM, it was observed that the interior of air vents in the bathroom of two isolation rooms, B1 and B2 were laden with dust.

At interview with Staff #2, Support Services Manager on 8/21/15 at 9:15 AM, he stated vent covers are cleaned daily by housekeeping staff except when the room is occupied. He reported the interior of the vent is cleaned by Facility Management only when it is observed to be dirty. At interview with Staff #3, of Corporate Services on 8/21/15 at approximately 9:20 AM, he confirmed that the department has no routine schedule for cleaning of the interior of air vents.