HospitalInspections.org

I.

235B.16 Information, education, and training requirements.

5. b. A person required to report cases of dependent adult abuse pursuant to sections 235B.3 and 235E.2, . . . shall complete two hours of training relating to the identification and reporting of dependent adult abuse within six months of initial employment . . . The person shall complete at least two hours of additional dependent adult abuse identification and reporting training every five years.

Based on personnel record review and staff interview the Critical Access Hospital (CAH) failed to ensure employees and contracted staff completed mandatory reporter training for dependent adult abuse, as required by state law. Problems were identified for 2 of 12 employees and 2 of 2 contracted sleep study staff selected for review. Administrative staff identified 87 CAH employees and 2 sleep study contracted staff who provide services to their patients.

Failure to ensure the required training is provided may potentially result in harm to the patient related to the lack of identification and reporting of abuse by staff.

Findings include:

1. Review of Staff D's personnel file revealed a hire date of 4/9/01, as a housekeeper. The personnel file lacked evidence of the completion of the required abuse training.

2. Review of Staff E's personnel file revealed a hire date of 9/10/87, as the Dietary Manager. The personnel file lacked evidence of the completion of the required abuse training.

3. Review of contracted Staff F's, sleep technician, personnel file revealed it lacked evidence of the completion of the required abuse training. Administrative staff identified Staff F has been under contract since 10/10/08.

4. Review of contracted Staff G's, sleep technician, personnel file revealed it lacked evidence of the completion of the required abuse training. Administrative staff identified Staff F has been under contract since 10/10/08.

During an interview on 9/23/14 at 11:45 AM, Staff L, Human Resources Director, confirmed Staff D has not completed the required abuse training because the CAH does not require it for housekeeping staff. She reported the CAH has talked about starting to require it, but had not made any changes yet.

During an interview on 9/23/14 at 2:15 PM, Staff L confirmed Staff E has not completed the required abuse training because the CAH only requires it for nursing staff and direct patient care staff, like lab and radiology. She acknowledged housekeeping and dietary staff have patient contact and will begin requiring it for all staff. Staff L reported she did not have any documentation to verify completion of the required abuse training for the contracted sleep study staff but would contact the company and request verification.

During an interview on 9/24/14 at 8:30 AM and 9:05 AM, Staff L reported the facility lacked a policy to address the requirement for mandatory abuse training for employees except in a clinic policy. She relayed she had not received any verification of the completion of abuse training for the contracted sleep study staff (Staff F and Staff G).


II.
Iowa Administrative Code, Chapter 51 titled "Hospitals", last updated 2/5/14, includes in part ".

51.24(3) Health examinations. Health examinations for all personnel shall be required at the commencement of employment and thereafter at least every four years. The examination shall include, at a minimum, the health status of the employee . . . Screening and testing for tuberculosis shall be conducted pursuant to 481-Chapter 59.

Based on personnel record review, policy review and staff interview the Critical Access Hospital (CAH) administrative staff failed to establish a consistent system to identify and prevent transmission of infections and communicable diseases for contracted employees. Problems were identified for 7 of 7 contracted staff selected for review. The CAH identified 16 staff contracted to provide services to patients.

Failure to identify infections and communicable diseases could potentially result in causing harm to patients through exposure and transmission of communicable diseases.

Finding include:

1. Review of the employee health file for Staff C, Registered Dietitian (RD), revealed the file lacked documentation of a health exam. Administrative staff identified Staff C has been under contract since 6/2/94.

Review of the employee health file for Staff F, Sleep Study Tech, revealed the file lacked documentation of a tuberculosis (TB) test and health exam. Administrative staff identified Staff F has been under contract since 10/10/08.

Review of the employee health file for Staff G, Sleep Study Tech, revealed the file lacked documentation of a TB test and health exam. Administrative staff identified Staff G has been under contract since 10/10/08.

Review of the employee health file for Staff H, Physical Therapy Assistant, revealed the file lacked documentation of a health exam. Administrative staff identified Staff H has been under contract since 7/1/12.

Review of the employee health file for Staff I, Speech Therapist, revealed the file lacked documentation of a health exam. Administrative staff identified Staff I has been under contract since 7/1/12.

Review of the employee health file for Staff J, Physical Therapist, revealed the file lacked documentation of a health exam. Administrative staff identified Staff J has been under contract since 7/1/12.

Review of the employee health file for Staff K, Occupational Therapist, revealed the file lacked documentation of a health exam. Administrative staff identified Staff K has been under contract since 7/1/12.

2. During an interview on 9/23/14, at 2:15 PM, Staff L, Human Resources Director, reported the CAH did not have any employee health information on the contracted staff selected, but would attempt obtain the requested information.

During an interview on 9/24/14 at 8:30 AM and 9:05 AM, Staff L reported she did not receive any verification of a health exam for any of the contracted staff selected for review or verification of a TB test for the contracted sleep study staff.

3. Review of an Employee Health policy titled "Employee Medical Examinations and Reviews", approved in 4/2014, revealed in part ". . . 3. b. Health review is required every four years . . . c. A health review will consist of a health history update, vital signs, height, weight, TB skin test . . . "

Based on observation, policy/procedure review and staff interview, the Critical Access Hospital (CAH) failed to complete periodic biomedical (biomed) electrical safety checks for 16 of 16 electric beds located on the nursing unit. The CAH administrative staff reported an average daily census of 1 to 2 patients. The CAH had no inpatients at the time of the survey.

Failure to complete required electrical safety inspections on patient care equipment could potentially result in patient harm due to electrical malfunction.

Findings include:

1. During an environmental tour of the nursing unit on 9/22/14 at 9:10 AM, Staff A, Chief Nursing Officer, verified the 16 electric beds lacked stickers to identify the last time they were inspected for electrical safety.

2. During an interview on 9/22/14 at 11:00 AM, Staff B, Materials Manager said he did not think the electric beds were part of the biomed inspection. Staff B said the biomed had not been completed on the electric beds for the last 2 years since he took over the biomed safety position because they did not get placed on the biomed checklist for the biomed company to check them.

3. Review of the manufacturer's guidelines for the electric beds, annual preventative maintenance includes checking the auxiliary outlet to ensure working properly and measuring current leakage and grounding continuity of the bed and the optional axillary outlet.

4. Review of the CAH policy titled "Medical Equipment Control" stated in part 3..."3. All medical equipment currently in use shall be entered into an equipment file system. Files shall be established for any new equipment at the time of purchase or lease. 4. Files shall also contain notations for the following: a. All repairs and preventive maintenance performed.

5. Review of the biomed contract between the CAH and HMS Health LLC dated 5/7/12 revealed a list of all equipment the company completed for the electrical safety checks. The Equipment List lacked the electric beds requiring electrical safety checks.