HospitalInspections.org

Based on record review and interview, the facility failed to ensure a physical environment free of pests.

The findings include:

Review of Facility's Pest Prevention Binder conducted on 8-9-12 revealed recurrent roach, fly and ant problems from June 2012 to August 7, 2012 in different areas of the Hospital including the CCU-ICU [Coronary Care Unit-Intensive Care Unit] visitor's lounge and NICU [Neurology Intensive Care Unit].

Review of the Pest Company's Pest Prevention Files conducted on 8-9-12 revealed a series of reports from 7-17-12 to 8-7-12 with repeat recommendations throughout the period to clean [specific targeted areas] and "the debris is pest harborage and minimizes the effectiveness of pesticide application."

Interview with the Assistant Director of Environmental Services conducted on 8-9-12 at 1025am confirmed the recurring roach, fly and ant problems as listed in the Pest Prevention Binder in spite of the twice weekly pest prevention maintenance.

Based on record review and interview, the facility failed to ensure that nursing staff assess and evaluate the quality and appropriateness of skin and wound care and its effect on one (#1) of 11 sample patients.

The findings include:

Clinical record review of Sample Patient (SP)#1 conducted from 8-8-12 to 8-9-12 revealed documentation by the Registered Nurse [RN] dated 7-13-12 at 830pm showing that SP#1's "skin is warm, dry, intact and elastic. Mucous membrane is moist and pink."

RN documentation dated 7-16-12 at 725pm showed that Integumentary [Skin] Assessment was "not WDL" [not within normal limits]. Further documentation showed "pressure ulcer, right buttock, sacrum; not intact/compromised." Documented interventions included but not limited to: "transparent dressing bony prominences, turn every 1-2 hours, wound consult, pressure reduction/specialty surface and position off skin breakdown."

Interview with the Physical Therapist conducted on 8-9-12 at 12noon revealed that she did SP#1's wound evaluation on 7-25-12 as ordered by the Physician. She stated that SP#1 was using the right type of bed at the time the wound evaluation was done.

Interview with the Director of Critical Care conducted on 8-9-12 at 235pm revealed that for Stage II pressure ulcers, no Physician wound care orders are needed. She explained that the nurses follow the Nursing Interventions as specified electronically following the Braden Assessment.

Interview with the Director of Critical Care conducted on 8-9-12 at 250pm confirmed that SP#1 had no skin breaks upon admission on 7-13-12. She confirmed that SP#1 developed skin breaks and Stage II pressure ulcers during his hospital stay. She also confirmed that the wound photograph taken on 8-9-12 showed that the wound has gotten worse compared to the wound photograph taken on 7-18-12.

Based on record review and interview, the facility failed to ensure that nursing staff develops and keeps a current nursing care plan for one (#1) of 11 sample patients.

The findings include:

Clinical record review of Sample Patient (SP)#1 conducted from 8-8-12 to 8-9-12 revealed a Plan of Care dated 7-22-12 addressing SP#1's cardiac status, comfort, neurological status, respiratory insufficiency, skin integrity and ventilator settings. There was no documented evidence of updated Plans of Care addressing SP#1's alteration in bowel function [bowel incontinence], impaired circulation [use of SCD: sequential compression device], potential for infection [due to invasive lines - CVP and NG tube, indwelling Foley catheter, ventilator and SP#1 ' s immune-compromised status] and alteration in nutrition [tube feedings due to the disease process].

Interview with the Director of Critical Care conducted on 8-9-12 at 240pm confirmed no updated Plans of Care addressing SP#1's NG [nasogastric] tube, CVP [central venous pressure] line, Foley catheter and tracheostomy.

Based on record review and interview, the facility failed to ensure a physical environment free of pests.

The findings include:

Review of Facility's Pest Prevention Binder conducted on 8-9-12 revealed recurrent roach, fly and ant problems from June 2012 to August 7, 2012 in different areas of the Hospital including the CCU-ICU [Coronary Care Unit-Intensive Care Unit] visitor's lounge and NICU [Neurology Intensive Care Unit].

Review of the Pest Company's Pest Prevention Files conducted on 8-9-12 revealed a series of reports from 7-17-12 to 8-7-12 with repeat recommendations throughout the period to clean [specific targeted areas] and "the debris is pest harborage and minimizes the effectiveness of pesticide application."

Interview with the Assistant Director of Environmental Services conducted on 8-9-12 at 1025am confirmed the recurring roach, fly and ant problems as listed in the Pest Prevention Binder in spite of the twice weekly pest prevention maintenance.

Based on record review and interview, the facility failed to ensure that nursing staff assess and evaluate the quality and appropriateness of skin and wound care and its effect on one (#1) of 11 sample patients.

The findings include:

Clinical record review of Sample Patient (SP)#1 conducted from 8-8-12 to 8-9-12 revealed documentation by the Registered Nurse [RN] dated 7-13-12 at 830pm showing that SP#1's "skin is warm, dry, intact and elastic. Mucous membrane is moist and pink."

RN documentation dated 7-16-12 at 725pm showed that Integumentary [Skin] Assessment was "not WDL" [not within normal limits]. Further documentation showed "pressure ulcer, right buttock, sacrum; not intact/compromised." Documented interventions included but not limited to: "transparent dressing bony prominences, turn every 1-2 hours, wound consult, pressure reduction/specialty surface and position off skin breakdown."

Interview with the Physical Therapist conducted on 8-9-12 at 12noon revealed that she did SP#1's wound evaluation on 7-25-12 as ordered by the Physician. She stated that SP#1 was using the right type of bed at the time the wound evaluation was done.

Interview with the Director of Critical Care conducted on 8-9-12 at 235pm revealed that for Stage II pressure ulcers, no Physician wound care orders are needed. She explained that the nurses follow the Nursing Interventions as specified electronically following the Braden Assessment.

Interview with the Director of Critical Care conducted on 8-9-12 at 250pm confirmed that SP#1 had no skin breaks upon admission on 7-13-12. She confirmed that SP#1 developed skin breaks and Stage II pressure ulcers during his hospital stay. She also confirmed that the wound photograph taken on 8-9-12 showed that the wound has gotten worse compared to the wound photograph taken on 7-18-12.

Based on record review and interview, the facility failed to ensure that nursing staff develops and keeps a current nursing care plan for one (#1) of 11 sample patients.

The findings include:

Clinical record review of Sample Patient (SP)#1 conducted from 8-8-12 to 8-9-12 revealed a Plan of Care dated 7-22-12 addressing SP#1's cardiac status, comfort, neurological status, respiratory insufficiency, skin integrity and ventilator settings. There was no documented evidence of updated Plans of Care addressing SP#1's alteration in bowel function [bowel incontinence], impaired circulation [use of SCD: sequential compression device], potential for infection [due to invasive lines - CVP and NG tube, indwelling Foley catheter, ventilator and SP#1 ' s immune-compromised status] and alteration in nutrition [tube feedings due to the disease process].

Interview with the Director of Critical Care conducted on 8-9-12 at 240pm confirmed no updated Plans of Care addressing SP#1's NG [nasogastric] tube, CVP [central venous pressure] line, Foley catheter and tracheostomy.