HospitalInspections.org

Based on findings from observation, document review, and interview, in 1 of 1 observations, nursing staff did not clarify a physician order for an intravenous medication and did not administer the medication according to the facility policy and procedure (P&P).

Findings include:

-- Per observation on 4/19/16 at 1:30 pm, Staff A prepared intravenous push (IVP) metoclopramide 15 mg. Staff A questioned the dose of the medication, stating "this seems like a high dosage, I have never pushed that amount before." He/she administered the medication to a patient without clarification.

-- Per review of the hospital's P&P titled, "Medication Administration by IV Therapy," last revised 6/2015, it indicated that registered nurses (RN) may administer certain medications by IVP. That list did not include the medication metoclopramide.

-- However, per interview of Staff B on 4/20/16 at 8:55 am, he/she indicated the facility has a new P&P in approval process that indicates a RN may push up to 10 mg of metoclopramide in single dose.

-- Per interview of Staff C on 4/20/16 at 11:30 am, up to 20 mg of metoclopramide may be administered IVP. However, per review of Physician Drug Reference 2016 (PDR.net) and Nursing 2013 Drug Handbook, doses of Reglan larger than 10 mg in 50 ccs should be diluted.

Based on findings from observation, interview and document review, lapses in infection control practices were identified in the hospital. Specifically, 1) hand hygiene was not performed as required and the current hand hygiene policy and procedure (P&P) was not adequate, 2) personal protective equipment (PPE) was not worn appropriately, 3) expired medications were available for patient use, 4) clean supplies were not stored appropriately and equipment was not cleaned between patients, 5) trash and soiled linen receptacles were stored in a public corridor outside the operating room (OR) suite, and 6) OR humidity and temperature were not within acceptable ranges.

Findings regarding (1) include:

-- Per observation on 4/19/16 at 9:40 am, Staff D did not perform hand hygiene after removing soiled gloves and before donning clean gloves while performing a peripherally inserted central catheter (PICC) insertion. He/she acknowledged this finding at time of observation.

-- Per observation on 4/20/16 at 11:00 am, Staff E did not perform hand hygiene before donning gloves to administer a respiratory treatment. He/she acknowledged this finding at time of observation.

-- Per observation on 4/19/16 at 11:30 am, Staff F did not perform hand hygiene before donning gloves to obtain a patient fingerstick or after removing the gloves. He/she acknowledged this finding at time of observation.

-- Per review of the facility's P&P titled "Employee Hand Washing," dated 3/2013, it lacked instruction to staff to perform hand hygiene when donning and doffing gloves.

Findings regarding (2) include:

-- Per observation on 4/19/16 at 9:40 am, Staff G did not wear gloves during a procedure (injecting eye with Lidocaine). Per interview of Staff G, he/she should have worn gloves during the procedure.

-- Per interview of Staff H on 4/19/16 at 10:45 am, gloves should be worn during all procedures in the OR.

-- Per review of the facility's P&P titled, "Standard and Transmission-Based Precautions," last revised 4/14/16, it indicated that standard precautions should be followed and gloves should be worn when contact with blood or body fluids, mucous membranes, or non-intact skin of a patient is anticipated.

Findings regarding (3) include:

-- Per observation on 4/19/16 at 1:30 pm, the medication refrigerator on Floor 2M, contained 2 opened multidose vials of Humulin insulin that were not labeled with the date and time opened; one (1) opened multidose vial of Humulin insulin dated as opened on 1/17/16 (approximately 2½ months earlier), and one (1) multidose vial of Novalog 70/30 insulin that was labeled with discard date 1/7/16 (2 months earlier).

-- Per interview of Staff I on 4/19/16 at 1:50 pm, the above findings were acknowledged.

Findings regarding (4) include:

-- The following were observed in the Emergency Department (ED) on 4/29/16 at 1:55 pm: twelve containers of PDI Sani-Cloth Bleach Wipes were stored in the dirty utility room and a linen cart and rolling bin containing clean linen were uncovered in main corridor.

-- Per interview with Staff J on 4/19/16 at 1:55 pm, the above findings were acknowledged.

-- Per observation on 4/20/16 at 11:00 am, Staff E used a stethoscope to auscultate a patient's lungs after administering a respiratory treatment. He/she then auscultated another patients lungs without cleaning the stethoscope between uses. At time of observation, Staff E indicated he/she only cleans/disinfects a stethoscope if a patient is on isolation.

Findings regarding (5) include:

-- Per observation on 4/19/16 at 11:30 am, in the public exit corridor outside the OR suite adjacent to Stairwell H there was a row of 10 waste receptacles (32 gallons each) labeled for "trash" and "soiled linen" that were not stored in an enclosed room with exhaust ventilation.

-- Per interview with Staff H on 4/19/16 at 11:40 am, these receptacles were used for the daily collection and storage of OR trash and soiled linens. He/she indicated that the receptacles are not picked up until the end.

Findings regarding (6) include:

-- Per review of the hospital's P&P titled "Categorical Waivers Declaration," last revised 1/18/16, relative humidity (RH) levels in the OR should be at a minimum of 20% RH. Per review of 2010 FGI Guidelines, temperatures in the OR must be at least 68 degrees Fahrenheit (F).

However, per review of OR humidity and temperature logs from 3/2016 and 4/2016, the above ranges were not consistently maintained. For example, on 3/25-3/26/16 RH readings were in the 12-15% range, on 3/29-3/30/16 RH readings were in the 8.2-14.4% range, on 3/28/16- 3/30/16 temperatures in OR #3 averaged between 63.5-65 degrees F, and on 4/1/16- 4/4/16 temperatures in OR #3 averaged 62-63 F.

-- Per interview with Staff K on 4/19/16 at 3:00 pm, the above readings were confirmed to be below the required ranges.