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Based on record review and staff interview it was determined that the hospital failed to ensure that the nursing staff maintained a current nursing care plan in accordance with physician's orders for daily weights for 2 of 2 relevant sample patient's (ID #'s 41 and 42).

Findings are as follows:

1. Clinical record review for patient ID #41 revealed a physician order dated 11/10/2012 for daily weights. Further record review determined that although the patient's weight was obtained on admission, there were no further weights obtained until 11/13/2012, when brought to the attention of the nurse manager.

2. Clinical record review for patient ID #42 revealed a physician order dated 11/6/2012 for daily weights. Further record review determined that although the patient's weight was obtained on admission, there were no further weights obtained until 11/13/2012, when brought to the attention of the nurse manager.

Interview on 11/13/2012 at 10:40 AM with the nurse caring for the patient revealed that she was unaware of the order for daily weights. Additionally, on 11/13/2012 at 10:45 AM when brought to the attention of the physician, he stated that he was unaware that the weights had not been obtained.

Based on record review, staff interview, and a review of the hospital policy entitled "Blood/Blood Components, Administration & Procedure", it was determined that the hospital failed to ensure that the hospital policy was implemented relative to informed consent for 2 of 3 relevant sample patients (ID #'s 3 and 42).

Findings are as follows:

A review of the hospital policy entitled "Blood/Blood Components, Administration & Procedure", under "Procedure for Blood/Blood Component Administration" states:

"Prior to obtaining blood/blood product from laboratory the registered nurse will", under bullet #2, "Verify informed consent. The informed consent is to be completed and signed by the physician ... prior to administration."

1. A review of the clinical record for patient ID #3 revealed a physician order dated 11/14/2012 to transfuse 2 units of packed red blood cells. Although the blood was transfused as ordered, a review of the consent for Transfusion of Blood Components dated 11/14/2012 revealed no evidence of a physician signature in accordance with the hospital policy.

2. A review of the clinical record for patient ID #42 revealed a physician order dated 11/5/2012 to transfuse 6 units of packed red blood cells. A review of the consent for Transfusion of Blood Components dated 11/5/2012 revealed no evidence of a physician's signature in accordance with the hospital policy.

During an interview on 11/14/12 at approximately 1:00 PM with the Executive Director of Inpatient Services, she was unable to produce evidence that the hospital policy and procedure related to informed consent for blood transfusions was followed.

Based on surveyor observations and staff interview, it was determined that the hospital failed to ensure that diagnostic radiology services are free of hazards for patients and personnel related to X-ray equipment and components.

Findings are as follows:

During testing of X-ray equipment and components in Diagnostic Imaging Room 1 on 11/14/12 at approximately 10 AM, surveyor observation revealed a GE (General Electric) table top malfunction determined to be a hazard to patients and personnel.

According to the manufacturer's recommendations for this equipment, it was noted that the table top involved should move easily with hydraulics. However surveyor observation had revealed that the table top was being operated manually due to a hydraulic malfunction.

During an interview on 11/14/12 at approximately 10:30 AM with the Director of Diagnostic Imaging, he reported that the staff had been aware of the malfunctioning table top and had not made him aware.

During subsequent interviews with staff, it was reported that the above equipment had been malfunctioning for some time.

Based upon surveyor observation and staff interview it was determined the hospital failed to maintain adequate facilities for its services.

Findings are as follows:

The 2007 Rhode Island Food Code, under Sewage, other liquid waste and rainwater, Section 5-402.11 Backflow Prevention states " ...a direct connection may not exist between the SEWAGE system and a drain originating from EQUIPMENT in which FOOD, portable EQUIPMENT, or UTENSILS are placed...."

Surveyor observation on 11/13/12 at 2:20 PM, of the ice machine on the Intensive Care Unit, revealed that the drainage tubing from the ice machine was inside the facility's drain pipe. There was no air gap between the ice machine tubing and the sewer system. This created a direct connection between the ice machine and sewer system.

Surveyor observation on 11/13/12 at 2:40 PM, of the ice machine in the Emergency Room area, revealed that the drainage tubing from the ice machine was inside the facility's drain pipe creating a direct connection between the ice machine and the sewer system.

During interview on 11/13/12 at 2:40 PM, the Food Service Director acknowledged there was a direct connection between the above ice machines and the sewage system.

Based on record review, staff interview and review of the hospital policy entitled "New England Organ Bank Protocol", it was determined that the hospital failed to notify the organ bank in a timely manner, for 3 of 12 records reviewed (ID#'s 35, 36, and 37).

Findings are as follows:

The hospital policy entitled "New England Organ Bank, Protocol" states under "Purpose" that "All deaths must be reported to the New England Organ Bank's 24-hour number.....within one hour of a patient's death....".

Review of clinical record documentation revealed the following:

1) Patient ID# 35 expired at 0630 hours. The New England Organ Bank (NEOB) was not notified by staff until 0830 hours.

2) Patient ID# 36 expired at 0450 hours. The NEOB was not notified by staff until 0630 hours.

3) Patient ID# 37 expired at 2245 hours. The NEOB was not notified by staff until 0030 hours.

During an interview on 11/16/12 at approximately 1:00 PM with the Executive Director of Quality, she was unable to explain the delay in contacting the NEOB.

Additionally, interview with the Nurse Educator on 11/16/12 at 9:25 AM revealed that although the NEOB protocol is verbally included in the employee orientation, there was no documented evidence that this training had been provided to employees during orientation.