HospitalInspections.org

The Critical Assess Hospital (CAH) reported a census of six patients. Based on observation and staff interview, the CAH failed to assure equipment and supplies used to treat emergency cases are readily available and did not exceed the manufactures safe use date. The CAH failed to assure the only pediatric emergency cart and two of two nosebleed treatment kits did not contain supplies that have not exceeded the manufacturer's expiration date.

Findings include:

- The pediatric emergency treatment cart, observed on 5/7/12 at 11:00am, revealed the following manufacturer's outdated supplies:

1. The pink/red intravenous (IV) start kit expired 2/11,
2. The purple IV start and intubation (airway) kits expired 2/11,
3. The yellow IV stat kit expired 8/10,
4. The white IV start kit expired 8/10
5. The blue IV start kit expired 8/10,
6. The orange IV stat kit expired 8/10,
7. The green IV start kit expired 8/10.

- The RapidRhino nosebleed treatment supply kit in Emergency Room (ER) #1 and 2, observed on 5/7/12 between 10:45am and 11:00am revealed 20 nasal packing packages with the manufacturer's outdate of 8/10, two years past the safe use date.


- Staff E, interviewed on 5/7/12 at 11:00am, confirmed the supplies that exceeded the manufactures' outdates and acknowledged the CAH lacks a procedure to assure all supplies needed for patient care in case of an emergency have not exceeded the manufacturer's expiration date.

The Critical Access Hospital (CAH) reported a census of??? six patients. Based on clinical record review, policy review, and staff interview, the CAH failed to assure staff follow their blood transfusion policy to ensure the safety of patients receiving blood products for 1 of 3 patients (patient #11).
Findings include:

- Review of the CAH policy "Blood Transfusions and Blood Reactions reviewed on 5/9/12 at 3:15pm "direct staff to "...Check blood label against patient's ID band and patient's blood ID band. This must be done by two nursing staff and documented on Transfusion Record prior to starting the blood..."

- Patient #11's clinical record reviewed on 5/8/12 at 9:30am revealed an admission date 1/5/12 with diagnosis of symptomatic anemia (low blood count) and gross hematuria (visible blood in urine). Patient #11 received 2 units of packed red blood cells on 1/5/12. Patient #11's clinical record lacked the required documentation of two nursing staff checking the blood label against patient identification band and patient blood identification band prior to starting the blood.

- Administrative staff B and Administrative staff C acknowledged Patient #11's clinical record lacked evidence two staff members checked the blood label against patient identification band and patient blood identification band prior to starting the blood.

The Critical Access Hospital (CAH) reported a census of six patients. Based on observation, staff interview and document review, the CAH failed to assure the premises are clean and orderly.

Findings include:

- The dietary kitchen and pantry, observed on 5/7/12 at 1:30pm contained the following non-cleanable surfaces:
1. Rust on the shelf under the dish processing area,
2. A metal floor under the dish processing area with rust and debris
3. Plumbing under the dish processing area with dust and debris
4. Exposed porous surfaces near the drains and holes in the tile in the wall under the dish processing area,
5. Water on the floor under the dishwasher,
6. Sticky debris on the floor at the wall around the cooking stove,
7. Shelves in the pantry with exposed wood.
8. The control box for the garbage disposal evidenced approximately two inches by four inches of missing paint and loose paint.

- Staff G interviewed on 5/9/12 at 2:20pm acknowledged the dietary kitchen and pantry contained non-cleanable surfaces and debris and confirmed the CAH lacked a procedure directing staff how to clean areas in the kitchen.

The Critical Access Hospital (CAH) reported a census of six patients. Based on observation, staff interview, and policy review the infection control officer failed to develop an active infection control system to identify, report, investigate, monitor, and implement infection control practices to ensure staff followed acceptable standards for two of six observed medication administrations and one of one cleaning of a discharged patient room.

Findings include:

- Staff C interviewed on 5/6/12 at 2:25pm verified they were responsible for the management of the infection control program. Staff C acknowledged they provide education to staff on hand hygiene and isolation precautions upon hire and annually thereafter. Staff C acknowledged they do not have a formal surveillance program with criteria for staff and environmental practices observing breaches in infection control practices. Staff C acknowledged the CAH developed a hand hygiene surveillance project in December of 2011.

- The CAH's Infection Prevention Program reviewed on 5/8/12 at 4:25pm directed "...Compliance with infection prevention practices is monitored and documented by...staff evaluation...observation of practices..."

- Staff I, observed on 5/7/12 at 11:10am, entered patient #29's room, a patient in contact isolation, to administer an intravenous (IV) medication. The door to patient #29's room contained a contact isolation precaution sign indicating staff must wear personal protective equipment of gloves and a gown to enter patient #23's room if anticipated contact with the patient. Staff I entered the room, performed hand hygiene, put on a gown and gloves. Staff I assisted the patient with repositioning then started to prepare to administer the medication. Staff I reached under their gown into their pocket of their uniform with their contaminated hand and pulled out an alcohol wipe to use on the IV tubing.

- The CAH's policy titled "Standard Precautions", reviewed on 5/9/12 at 2:05pm, revealed hand hygiene is to be performed "...immediately after gloves are removed ...".

- Staff E, observed on 5/7/12 at 3:00pm prepared injections for patient #32. Staff E removed their protective gloves, exited the room, and failed to perform hand hygiene. Staff E returned to the room and put on a pair of gloves then administered the injections.

- Observation on 5/9/12 at 11:30am of Staff F cleaning a discharged patient room revealed the following breeches in infection control.

- Staff F applied protective gloves, cleaned the sink and toilet, and removed their gloves. Staff F applied another pair of gloves, cleaned other areas in the room, and finished cleaning the sink and toilet. Staff F replaced the cleaning chemicals on the housekeeping cart, removed their gloves and obtained a dust mop. Staff F dust mopped the floor, placing the collected debris in an area then shook the dust mop over the debris. Staff F used a hand broom and dustpan to collect the debris. Staff F cleaned the room doorknob and bathroom doorknob, and then went to the linen closet in the hall to obtain linens for the bed. Staff F applied gloves, wiped the overhead trapeze, removed their gloves and made the bed. Staff F obtained the wet mop to clean the floor. Staff F leaned the wet mop handle against the bed and linens. Staff F failed to perform hand hygiene three times after removing potentially soiled gloves.

- Staff C, interviewed on 5/9/12 at 2:30pm, acknowledged staff are to perform hand hygiene after removing protective gloves. Staff C acknowledged the CAH lacked a procedure directing staff how to perform floor care.

The Critical Access Hospital (CAH) reported a census of six patients. Based on document review and staff interview, the CAH failed to date and time when standing orders were implemented for 18 of 20 inpatient clinical records reviewed (patient #'s 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 22, 24, 25, 26, 27, 28, 29, and 30).

Findings include:

- The CAH's Rules and Regulations of the Medical Staff reviewed on 5/9/12 at 12:30pm directed "...Standing orders shall be signed by the attending physician or designated non-physician provider..."

- Patient #19's clinical record reviewed on 5/7/12 at 10:45am revealed an admission date of 4/16/12 with a diagnosis of status post right hip fracture. Patient #19's clinical record revealed a standing order for flush protocol of an intravenous (IV) lock. The standing order contained the patient's name but lacked a date or time when to implement the order. The standing order lacked a provider's identification or signature.

- Patient #20's clinical record reviewed on 5/7/12 at 1:00pm revealed an admission date of 5/3/10 with a diagnosis of back pain. Patient #19's clinical record revealed a standing order. The standing order contained the patient's name but lacked a date or time when to implement the order. The standing order lacked a provider's identification or signature.

- Patient #22's clinical record reviewed on 5/7/12 at 1:40pm revealed an admission date of 4/19/12 with a diagnosis of Leukocytosis (a raised white blood cell count above the normal range in the blood). Patient #22's clinical record revealed a standing order. The standing order contained the patient's name but lacked a date or time when to implement the order. The standing order lacked a provider's identification or signature.

Staff B, interviewed on 5/9/12 at 11:35am acknowledged standing orders require the prescribing physician signature and when standing orders are implemented they should have a date and time when to implement the orders.

This deficient practice also affected patient # ' s 11, 12, 13, 14, 15, 16, 17, 18, 24, 25, 26, 27, 28, 29, and 30).

The Critical Assess Hospital (CAH) reported a census of six patients. Based on observation and staff interview, the CAH failed to assure equipment and supplies used to treat emergency cases are readily available and did not exceed the manufactures safe use date. The CAH failed to assure the only pediatric emergency cart and two of two nosebleed treatment kits did not contain supplies that have not exceeded the manufacturer's expiration date.

Findings include:

- The pediatric emergency treatment cart, observed on 5/7/12 at 11:00am, revealed the following manufacturer's outdated supplies:

1. The pink/red intravenous (IV) start kit expired 2/11,
2. The purple IV start and intubation (airway) kits expired 2/11,
3. The yellow IV stat kit expired 8/10,
4. The white IV start kit expired 8/10
5. The blue IV start kit expired 8/10,
6. The orange IV stat kit expired 8/10,
7. The green IV start kit expired 8/10.

- The RapidRhino nosebleed treatment supply kit in Emergency Room (ER) #1 and 2, observed on 5/7/12 between 10:45am and 11:00am revealed 20 nasal packing packages with the manufacturer's outdate of 8/10, two years past the safe use date.


- Staff E, interviewed on 5/7/12 at 11:00am, confirmed the supplies that exceeded the manufactures' outdates and acknowledged the CAH lacks a procedure to assure all supplies needed for patient care in case of an emergency have not exceeded the manufacturer's expiration date.

The Critical Access Hospital (CAH) reported a census of??? six patients. Based on clinical record review, policy review, and staff interview, the CAH failed to assure staff follow their blood transfusion policy to ensure the safety of patients receiving blood products for 1 of 3 patients (patient #11).
Findings include:

- Review of the CAH policy "Blood Transfusions and Blood Reactions reviewed on 5/9/12 at 3:15pm "direct staff to "...Check blood label against patient's ID band and patient's blood ID band. This must be done by two nursing staff and documented on Transfusion Record prior to starting the blood..."

- Patient #11's clinical record reviewed on 5/8/12 at 9:30am revealed an admission date 1/5/12 with diagnosis of symptomatic anemia (low blood count) and gross hematuria (visible blood in urine). Patient #11 received 2 units of packed red blood cells on 1/5/12. Patient #11's clinical record lacked the required documentation of two nursing staff checking the blood label against patient identification band and patient blood identification band prior to starting the blood.

- Administrative staff B and Administrative staff C acknowledged Patient #11's clinical record lacked evidence two staff members checked the blood label against patient identification band and patient blood identification band prior to starting the blood.

The Critical Access Hospital (CAH) reported a census of six patients. Based on observation, staff interview and document review, the CAH failed to assure the premises are clean and orderly.

Findings include:

- The dietary kitchen and pantry, observed on 5/7/12 at 1:30pm contained the following non-cleanable surfaces:
1. Rust on the shelf under the dish processing area,
2. A metal floor under the dish processing area with rust and debris
3. Plumbing under the dish processing area with dust and debris
4. Exposed porous surfaces near the drains and holes in the tile in the wall under the dish processing area,
5. Water on the floor under the dishwasher,
6. Sticky debris on the floor at the wall around the cooking stove,
7. Shelves in the pantry with exposed wood.
8. The control box for the garbage disposal evidenced approximately two inches by four inches of missing paint and loose paint.

- Staff G interviewed on 5/9/12 at 2:20pm acknowledged the dietary kitchen and pantry contained non-cleanable surfaces and debris and confirmed the CAH lacked a procedure directing staff how to clean areas in the kitchen.

The Critical Access Hospital (CAH) reported a census of six patients. Based on observation, staff interview, and policy review the infection control officer failed to develop an active infection control system to identify, report, investigate, monitor, and implement infection control practices to ensure staff followed acceptable standards for two of six observed medication administrations and one of one cleaning of a discharged patient room.

Findings include:

- Staff C interviewed on 5/6/12 at 2:25pm verified they were responsible for the management of the infection control program. Staff C acknowledged they provide education to staff on hand hygiene and isolation precautions upon hire and annually thereafter. Staff C acknowledged they do not have a formal surveillance program with criteria for staff and environmental practices observing breaches in infection control practices. Staff C acknowledged the CAH developed a hand hygiene surveillance project in December of 2011.

- The CAH's Infection Prevention Program reviewed on 5/8/12 at 4:25pm directed "...Compliance with infection prevention practices is monitored and documented by...staff evaluation...observation of practices..."

- Staff I, observed on 5/7/12 at 11:10am, entered patient #29's room, a patient in contact isolation, to administer an intravenous (IV) medication. The door to patient #29's room contained a contact isolation precaution sign indicating staff must wear personal protective equipment of gloves and a gown to enter patient #23's room if anticipated contact with the patient. Staff I entered the room, performed hand hygiene, put on a gown and gloves. Staff I assisted the patient with repositioning then started to prepare to administer the medication. Staff I reached under their gown into their pocket of their uniform with their contaminated hand and pulled out an alcohol wipe to use on the IV tubing.

- The CAH's policy titled "Standard Precautions", reviewed on 5/9/12 at 2:05pm, revealed hand hygiene is to be performed "...immediately after gloves are removed ...".

- Staff E, observed on 5/7/12 at 3:00pm prepared injections for patient #32. Staff E removed their protective gloves, exited the room, and failed to perform hand hygiene. Staff E returned to the room and put on a pair of gloves then administered the injections.

- Observation on 5/9/12 at 11:30am of Staff F cleaning a discharged patient room revealed the following breeches in infection control.

- Staff F applied protective gloves, cleaned the sink and toilet, and removed their gloves. Staff F applied another pair of gloves, cleaned other areas in the room, and finished cleaning the sink and toilet. Staff F replaced the cleaning chemicals on the housekeeping cart, removed their gloves and obtained a dust mop. Staff F dust mopped the floor, placing the collected debris in an area then shook the dust mop over the debris. Staff F used a hand broom and dustpan to collect the debris. Staff F cleaned the room doorknob and bathroom doorknob, and then went to the linen closet in the hall to obtain linens for the bed. Staff F applied gloves, wiped the overhead trapeze, removed their gloves and made the bed. Staff F obtained the wet mop to clean the floor. Staff F leaned the wet mop handle against the bed and linens. Staff F failed to perform hand hygiene three times after removing potentially soiled gloves.

- Staff C, interviewed on 5/9/12 at 2:30pm, acknowledged staff are to perform hand hygiene after removing protective gloves. Staff C acknowledged the CAH lacked a procedure directing staff how to perform floor care.

The Critical Access Hospital (CAH) reported a census of six patients. Based on document review and staff interview, the CAH failed to date and time when standing orders were implemented for 18 of 20 inpatient clinical records reviewed (patient #'s 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 22, 24, 25, 26, 27, 28, 29, and 30).

Findings include:

- The CAH's Rules and Regulations of the Medical Staff reviewed on 5/9/12 at 12:30pm directed "...Standing orders shall be signed by the attending physician or designated non-physician provider..."

- Patient #19's clinical record reviewed on 5/7/12 at 10:45am revealed an admission date of 4/16/12 with a diagnosis of status post right hip fracture. Patient #19's clinical record revealed a standing order for flush protocol of an intravenous (IV) lock. The standing order contained the patient's name but lacked a date or time when to implement the order. The standing order lacked a provider's identification or signature.

- Patient #20's clinical record reviewed on 5/7/12 at 1:00pm revealed an admission date of 5/3/10 with a diagnosis of back pain. Patient #19's clinical record revealed a standing order. The standing order contained the patient's name but lacked a date or time when to implement the order. The standing order lacked a provider's identification or signature.

- Patient #22's clinical record reviewed on 5/7/12 at 1:40pm revealed an admission date of 4/19/12 with a diagnosis of Leukocytosis (a raised white blood cell count above the normal range in the blood). Patient #22's clinical record revealed a standing order. The standing order contained the patient's name but lacked a date or time when to implement the order. The standing order lacked a provider's identification or signature.

Staff B, interviewed on 5/9/12 at 11:35am acknowledged standing orders require the prescribing physician signature and when standing orders are implemented they should have a date and time when to implement the orders.

This deficient practice also affected patient # ' s 11, 12, 13, 14, 15, 16, 17, 18, 24, 25, 26, 27, 28, 29, and 30).