HospitalInspections.org

Based on observation, interview and record review the facility failed to maintain an emergency department capable of handling emergencies when the (2) Emergency Crash Carts were not being checked for readiness and contained expired emergency medications.

Findings include:

An observation on the afternoon of 10/1/19, in the facility's emergency department revealed the Crash Cart's defibrillator machine, in front of Exam room #5, had not been tested since 9/10/19.

An observation on the afternoon of 10/2/19, in the facility's emergency department revealed the Crash care in Exam room #1 had not been tested on 10/2/19 and there was no record of when it had last been tested.

Further observation revealed the following emergency medications were expired:
(1) Nitrostat 0.4 mg tablet, 23-tab bottle, 11 tablets had been removed, the bottle did not have an expiration date.
(1) Epinephrine 1 mg/ml, expiration 8/2019
(3) Dextrose 50%, expiration June 2019
(2) Calcium Chloride 100mg/ml, expiration 5/2019

And a Quick Trach kit that had expired on 8/2017

Review of the facility provided policy Procurement and dispensing Drugs Emergency Department (ED) Crash Caret (dated 7/18) reflected, " ...The pharmacist should check the ED crash cart monthly for maintenance of stock levels and for presence of expired drugs on the cart."

During an interview on 10/2/19, Staff #4, DON confirmed the findings.

Based on interview and record review the facility failed to ensure the medical staff's privileges were requested and approved.

Findings include:

Review of the medical Staffs (#9, NP, #10, MD, and #11, MD) revealed the facility did not have evidence of the requested and approved privileges for the physicians and the Nurse Practioner.

Review of the facility provided document Bylaws of the Medical Staff of Parkview Hospital (undated) reflected in part
Appointment Process
" ...5.4.1.2 Within ninety (90) days after the date on which a completed application was submitted ... All recommendations to appoint must also specifically recommend the clinical privileges to be granted, which may be qualified by probationary conditions ....5.4.3 Notice of final Decision. The CEO shall, within twenty (20) days of the Board's final decision, give notice of the final decision to the Medical Staff and the Applicant. A decision to appoint or reappoint shall include, if applicable: the staff category to which the Applicant is appointed; the clinical privileges granted; and any special conditions attached to appointment ..."

During an interview on the afternoon of 10/1/19, in the conference room, Staff #4, DON confirmed the findings.

Based on observation, interview and record review the facility failed to provide a sanitary environment when items were being stored under the handwashing sinks.

Findings include:

Observations during a tour of the facility's emergency department on 10/2/19 revealed the following:

Exam room #3- A delivery kit containing: Sterile towels, Sterile Forceps and (2) Sterile Speculums.
Exam room #4- an open stiff neck brace.
Patient's Nutrition room- a patient blanket and towel

During the tour Staff #4, DON confirmed the findings.

Based on record review and interview the facility failed to provide organized nursing services when:

a.) A Physician's order for Occupational therapy was changed without the physician's consent, preventing the patient from receiving needed services.

b.) The Patient #20 was not weighed, and the height was not obtained on admission, preventing the facility from determining if the patient was below his/her ideal body weight and to monitor for significant weight loss.

c.) The nurses did not record the physician ordered urinary output levels. (Patient #7)

Findings include:

a.) Review of Patient #2's medical records reflected a 70-year-old-male admitted with a diagnosis of multiple vertebral and rib fractures.

Review of the Physician's note dated 8/21/19 reflected, "Plan/ED intervention ...
6. PT/OT to eval [sic] and work closely with Ortho recommendations ..."

During an interview on the morning of 10/2/19, Staff #11, MD stated in part that he had made a mistake in ordering the OT.

During an interview on the morning of 10/2/19, when asked for the admitting orders, Staff #4, DON stated the Plan were the admitting orders. Staff #4, stated, "We don't have OT here ... we will not accept patients needing OT." Staff #4 confirmed the nurse did not clarify the order with the physician.

b.) Review of the facility provided policy Admission, Patient (dated 7/18) reflected, "C. Nursing Staff should: 2. Weigh and measure the height of the patient before being taken to his/her room unless otherwise indicated.

Review of Patient #20's medical records reflected an admission on 8/3/19 with a diagnosis of Weakness, dizzy after a CABG surgery. The admitting nurse did not record the patient's weight or height.

Review of Patient #20's meal intake revealed the following:
8/3/19- 30% for supper
8/6/19- no meals were intake recorded
8/7/19- 20% breakfast, 50% lunch, and 10% supper

Review of the recorded weights revealed on 8/6/19 a weight of 155 lbs. and on 8/11/19 at weight of 142 lbs.

During an interview on the morning of 10/2/19, Staff #40 confirmed the findings and confirmed that without the admitting weight and Patient #20's poor intake, the amount of weight loss could not be determined.

c.) Review of the facility provided policy Intake and Output (dated 8/18) reflected, "POLICY: 1. the fluid intake and output of a patient should be monitored and recorded when ordered by the physician ..."

Review of Patient #7's medical records reflected a 92-year-old-female admitted on 8/6/19 with a diagnosis of dehydration, Rhabdomyolysis, Anemia, and Hematuria.

Review of the physician's order dated 8/6/19 reflected, "Insert Foley catheter and record the urinary input and output."

Review of the Urinary output record reflected
On 8/7/19- there was no urinary output recorded for the day and evening shifts. The nurses did not document a physician notification, or the interventions put in place, for the possible urinary retention.

During an interview on the morning of 10/2/19, Staff #40 confirmed the findings.

Based on record review and interview the facility failed to provide activities for (4) out of (4) patients in the facilities swing beds when the facility did not conduct comprehensive Activity assessments. (Patients #1, 2, 3, 4)

Findings include:

Review of Patients #1, 2, 3, 4's medical records reflected the Activity Director had not completed an Activity Assessment or put activity interventions in place during the patient's stay.

Patient #1 was admitted on 8/5/19 and discharged 18 days later 8/23/19.
Patient #2 was admitted on 8/21/19 and discharged 21 days later 9/11/19.
Patient #3 was admitted on 9/18/19 and discharged 4 days later 9/22/19
Patient #4 was admitted on 7/8/19 and discharged 10 days later 7/18/19.

Review of the facility provided policy (undated) reflected, "Patient Activities: Upon admission, you will receive a visit from the patient Activities Director. He/she will assist you in providing an activity you enjoy. From time to time, this may be adjusted to reflect you changing interests ..."

During an interview on 10/2/19, in the facility conference room, Staff #4, DON confirmed the findings. When asked for an Activity Director's job description, Staff #4, DON stated, "We don't have one."

Based on record review and interview the facility failed to provide a treatment plan with all team members present and/or a comprehensive care plan with the patients input for (4) out of (4) patients in the facilities swing beds. (Patients #1, 2, 3, 4)

Review of the medical records reflected:

Patient #1 was admitted on 8/5/19. The Activity, Dietary, and Social Worker were not present at the interdisciplinary team meeting. There was no evidence Patient #1 had participated in the care plan.

Patient #2 was admitted on 8/21/19. The Activity, Dietary, Social Worker were not present at the interdisciplinary team meeting. Patient #3 was a diabetic and had depression; the care plan did not include the risk for hypo/hyperglycemia and depression.

Patient #3 was admitted on 9/18/19. The Activity, Dietary, and Social Worker were not present at the interdisciplinary team meeting. Patient #3 did not have a care plan.

Patient #4 was admitted on 7/8/19. There was no evidence of a treatment plan meeting.

During an interview on 10/2/19, Staff #4, DON confirmed the findings.