HospitalInspections.org

Based on a tour of the facility and a review of facility documents, the governing body was not responsible for services furnished in the hospital. This was evidenced by non-registered nurses performing patient assessments, outdated medications being available for patient use, medication improperly packaged by the pharmacy, dietary staff not following their own policies and procedures and adequate hot water not available in the pre-operative area for surgical scrubbing.

Findings were:

During a tour of the emergency department on the afternoon of 11-30-10, the surveyor observed patient #21 enter the emergency department, be placed in a room by a licensed vocational nurse (staff #2) and assessed by the same LVN. Telephone orders were obtained by the LVN (staff #2) and treatment was begun on patient #21. At no time during the previously noted actions was a registered nurse present in the emergency department.

Facility job description titled ER Nurse states, in part, " ...A LVN may work in ER but the RN is to perform all patient assessments. "

During a tour of the emergency department on the afternoon of 11-30-10, ten of ten syringes of liquid Tylenol with codeine (packaged by the pharmacy staff) were filled to the 5 ml mark but contained an air bubble at the top of the syringe.

During a tour of the patient care unit on the afternoon of 11-30-10, one of one vial of Apidra insulin (with an " open " date of 10-18-10) was found in the medication refrigerator, available for patient use. According to the manufacturer ' s package insert (revised February 2009), " opened vials, whether or not refrigerated, must be used within 28 days. "

During a tour of the kitchen area on the afternoon of 11-30-10, the ice scoop was found sitting in the ice in one of one icemaker. A sign posted on the icemaker stated, " Do not leave the scoop laying on the ice. "

During a tour of the kitchen area on the afternoon of 11-30-10, a metal cash box was found in a patient food freezer. When the dietary director was asked by the surveyor what the item was and the reason for it being in the freezer, the dietary director stated that it contained money received by the kitchen for staff and visitor lunches and that it was stored in the freezer to discourage theft.

During a tour of the surgical area on the afternoon of 11-30-10, an inspection of three surgical scrub sinks revealed that two of the three sinks provided no hot water even after 4 minutes of the water running continuously at high pressure.

The above was confirmed in an interview with the Director of Nursing and the HIS Director on the evening of 11-30-10 in the hospital conference room.

Based on observation and a tour of the facility, the nursing service did not have an adequate number of licensed registered nurses to provide nursing care to all patients as needed, and there was not the immediate availability of a registered nurse to provide bedside care of an emergency department patient.

Findings were:

During a tour of the emergency department on the afternoon of 11-30-10, the surveyor observed patient #21 enter the emergency department, be placed in a room by a licensed vocational nurse (staff #2) and assessed by the same LVN. Telephone orders were obtained by the LVN (staff #2) and treatment was begun on patient #21. At no time during the previously noted actions was a registered nurse present in the emergency department.

The above was confirmed in an interview with the Director of Nursing and the HIS Director on the evening of 11-30-10 in the hospital conference room.

Based on observation, drugs and biologicals were not controlled and distributed in accordance with applicable standards of practice.

Findings were:

During a tour of the emergency department on the afternoon of 11-30-10, ten of ten syringes of liquid Tylenol with codeine (packaged by the pharmacy staff) were filled to the 5 ml mark but contained an air bubble at the top of the syringe.

During a tour of the patient care unit on the afternoon of 11-30-10, one of one vial of Apidra insulin (with an " open " date of 10-18-10) was found in the medication refrigerator, available for patient use. According to the manufacturer ' s package insert (revised February 2009), " opened vials, whether or not refrigerated, must be used within 28 days. "

The above was confirmed in an interview with the Director of Nursing and the HIS Director on the evening of 11-30-10 in the hospital conference room.

Based on observation and a tour of the facility, outdated drugs were available for patient use.

Findings were:

During a tour of the patient care unit on the afternoon of 11-30-10, one of one vial of Apidra insulin (with an " open " date of 10-18-10) was found in the medication refrigerator, available for patient use. According to the manufacturer ' s package insert (revised February 2009), " opened vials, whether or not refrigerated, must be used within 28 days. "

The above was confirmed in an interview with the Director of Nursing and the HIS Director on the evening of 11-30-10 in the hospital conference room.

Based on a tour of the facility, the hospital did not have a full-time director of the food and dietetic service that was responsible for the daily management of the dietary services.

Findings were:

During a tour of the kitchen area on the afternoon of 11-30-10, the ice scoop was found sitting in the ice in one of one icemaker. A sign posted on the icemaker stated, " Do not leave the scoop laying on the ice. "

During a tour of the kitchen area on the afternoon of 11-30-10, a metal cash box was found in a patient food freezer. When the dietary director was asked by the surveyor what the item was and the reason for it being in the freezer, the dietary director stated that it contained money received by the kitchen for staff and visitor lunches and that it was stored in the freezer to discourage theft.

The above was confirmed in an interview with the Director of Nursing and the HIS Director on the evening of 11-30-10 in the hospital conference room.