HospitalInspections.org

Based on interview and record review, the hospital's registered nurse (RN) did not supervise and evaluate the nursing care for each patient in that, a licensed vocational nurse (LVN) was allowed to conduct inpatient assessments without a RN validating and/or further assessing these inpatients, citing 2 of 4 inpatients/closed medical records (Patient #6 and #7) that stayed in the hospital greater than 2 days from September 2018 through January 2019.

Findings included:

Patient #6 was admitted to the hospital after undergoing a surgical procedure "left reverse total shoulder arthroscopy" on 10/16/18. On 10/18/19 and 10/19/18, a LVN took care of Patient #6. There was no evidence in the medical record that a RN validated the LVN's patient assessments. Patient #6 was discharged on 10/19/18.

Patient #7 was admitted to the hospital after undergoing a surgical procedure "open reduction and internal fixation, left greater trochanteric fracture..." on 09/17/18. On 09/19/18, a LVN took care of Patient #7. There was no evidence in the medical record that a RN validated the LVN's patient assessments. Patient #7 was discharged on 09/24/18.

In interview on 02/20/19 at 1:35 PM, Personnel # 34 who was present during the medical records review confirmed the findings.

Hospital policy PC-015-F "LVN Scope of Practice...Patient Care Services" revised 10/21/16 required "...LVNs are NOT independent practitioners...Assessment. The LVN nursing assessment is defined as the collection of data...VALIDATION of assessment data must be done by the RN..."

Based on observation and interview the hospital failed to ensure the dietary department requirements were in compliance in that the following was observed:

1) Food stored into the reach in cooler was open and unlabeled.

2) An assortment of pans were stored wet and were stacked upon one another.

Findings included

During a tour of the facility's only kitchen on 02/20/19 between 09:05 AM and 09:25 AM the following was observed. Personnel #23 was present and verbally confirmed the findings below:

1) A one third pan of cooked chicken, a plastic bag of cut french fries, and a plastic bag of cut sweet potato fries were unlabeled.

2) Two of 8 one eighth were stored wet and stacked upon one another on a shelf.

TFER 228.123 (a) (2) (A)
"...Storage.
(a) Equipment, utensils, linens, and single-service and single-use articles.
(1) Except as specified in paragraph (4) of this subsection, cleaned equipment and utensils, laundered linens, and single-service and single-use articles shall be stored:
(A) in a clean, dry location;
(B) where they are not exposed to splash, dust, or other contamination; and
(C) at least 15 cm (6 inches) above the floor.
(2) Clean equipment and utensils shall be stored as specified under paragraph (1) of this subsection and shall be stored:
(A) in a self-draining position that allows air drying..."

TFER 228.75 (g)(1)
"...food prepared and held in a food establishment for more than 24 hours shall be clearly marked to indicate the date or day by which the food shall be consumed on the premises, sold, or discarded...for a maximum of 7 days. The day of preparation shall be counted as day 1."

Based on observation, interview, and record review, the designated infection control officer did not implement policies governing appropriate hand hygiene and cleaning of reusable patient care equipment on 02/20/19.

Findings included:

On 02/20/19 the following was observed:

(1) At 09:50 AM, Tracer Patient #10 was followed going to the preoperative area. After weighing the patient, Personnel #35 did not sanitized the stand-on weight scale the proper way. Instead of sanitizing the equipment from the less contaminated to the most contaminated areas, she performed the sanitizing process the opposite way. Personnel #35 did not perform appropriate hand hygiene after sanitizing the equipment. Personnel #14 who was with the surveyor confirmed the findings.

(2) At 10:21 AM in the preoperative area bed #11, Personnel #36 was priming an IVF (intravenous fluid). She then took off her gloves. Without appropriate hand hygiene, she provided direct patient care to Patient #10.

(3) At 10:35 AM after performing an intravenous start, Personnel #36 took off her gloves. Without appropriate hand hygiene, she provided direct patient care to Patient #10.

At 10:41 AM Personnel # 14 who was with the surveyor was informed of #2 and #3 findings and confirmed the findings.

(4) At 11:28 AM, Tracer Patient #22 was followed to operating room (OR) #2. Patient #22 was scheduled for "cystoscopy, transurethral resection of prostate with PK loop." At 11:33 AM, Personnel # 37 took off her gloves. Without appropriate hand hygiene, she opened a medicine vial, wiped the rubber septum with alcohol, drew up the medicine in a syringe, and injected the medicine via intravenous push (IVP) to Patient #22. At 11:36 AM, Personnel #37 took off her gloves and provided direct patient care. At 11:50 AM Personnel #37 took off her gloves. Without appropriate hand hygiene, she drew up Propofol and administered the medicine to Patient #22.

(5) At 11:40 AM, Personnel #38 took off her gloves and put on a clean pair of gloves without appropriate hand hygiene.

On 02/20/19 at 12:00 PM, Personnel #10 was informed of #4 and #5 findings and confirmed the findings.

Hospital policy "Hand Hygiene...Infection Control" revised 05/31/17 required "Procedure Guidelines...B. Indication for Handwashing...before and after having direct contact with a patient...After contact with inanimate objects, including medical equipment...After removing gloves." These procedure guidelines were also for indicated for handrubbing.

Hospital policy "Cleaning of Reusable Patient Care Equipment...Infection Control" revised 04/17/2018 required "...To provide clean equipment for patient use and to prevent cross-contamination between patients..."