HospitalInspections.org

The Critical Access Hospital (CAH) reported a census of 14 patients. Based on observation, policy review and staff interview the CAH failed to ensure staff followed their handwashing policy for infection prevention.

Findings include:

- Review of the policy, "Handwashing Guidelines", directed staff to "Always use hand hygiene":
1.) Before any patient contact
2.) Before performing an invasive procedure
3.) After contact with patients skin .........

- Random observations on 10/09/12 at 7:30am revealed staff A administered oral medications to patient #39. Patient #12 located in the room across the hall's Intravenous (IV) machine began to alarm. Staff A exited patient #39's room and failed to perform hand hygiene as they exited the room. Staff A entered Patient #12's room and failed to perform hand hygiene when they entered the room. Staff A checked the IV site on patient #12, flushed the IV, changed the IV pump, and failed to perform hand hygiene when they exited the room. Staff A returned to patient #39's room and failed to perform hand hygiene as they re-entered the room to complete medication administration. Staff A went to another patient room (216) and failed to perform hand hygiene when they entered the room, applied a nicotine patch and failed to perform hand hygiene when they exited the room.

- Random observations on 10/9/12 at 11:00am revealed staff D failed to perform hand hygiene when they entered patients room 220, performed an assessment of the patient and failed to perform hand hygiene when they exited the room.

- Interview on 10/10/12 at 11:30am with staff E revealed the hospital follows CDC guidelines and all staff need to perform hand hygiene when entering and exiting any patient room.

The Critical Access Hospital (CAH) reported a census of 14 patients'. Based on observation and staff interview the CAH failed to secure drugs in two of two anesthesia medication carts observed in the operating room (OR)/surgery suite.

Findings included:

- Document review on 10/10/12 of the "Standard Operating Policies and Procedures" titled, "Medications and Controlled Subtance Storage and Access in the Surgical Environment" revised on 4/16/12 directed surgical staff to lock all prescribed medication in the Anesthesia Room when not in use.

- Observation on 10/9/12 at 10:40am of the main operating room revealed two unlocked anesthesia medication carts in the unlocked operating room. The two unlocked anesthesia medication cart contained the following:
1. One 50ml (milliliter) injection of 8.4% Sodium Bicarbonate (used in emergency situations),
2. One 50ml injection of Dextrose (used to treat low blood sugar) 25 grams,
3. One 10ml injection of Calcium Chloride (used in emergency situations),
4. Three 10ml Epinephrine (used in life threatening allergic reactions) 1:10000,
5. Five 2ml vials of Reglan (used to treat slowed stomach emptying),
6. Two 1ml ampules of Epinephrine 1:1000,
7. Four 50mg (milligrams)/1ml vials of Diphenhydramine (used to treat life threating allergic
reactions),
8. Four 1ml vials of Naloxone (used to reverse a narcotic) and,
9. Two 20ml vial of Atropine Sulfate Ing. 0.1mg/ml injections (used to treat breathing difficulties).
10. Two Lidicaine HCL 20mg/ml single dose vial
11. Two Epinephrine 1ml single dose vials (used in emergency situations)
12. Four Cefazolin Sodium 1gram single dose vials (a perioperative prophylaxis/antibiotic)
13. Six Digoxin 2 ml single dose vials (a cardiac drug)
14. Two 5ml and two 2ml single dose vials of Flumazenil (an antidote)
13. Two 1mg ampules of Labetalol (an antihypertensive)
14. Two 5ml vials of Methylene blue (an antidote)
15. Two 10ml vials of Neostigmine Methylsulfate (an antidote)
16. Six 2ml vials of Ondansetron Hydrochloride (an antiemetic)
17. Ten 2ml vials of Robinul (antimuscarinic agent, antispasmodic)
18. Two 2ml single dose vials of Solu-Cortef (anti-inflammatory agent)
19. Two 10mg vials of Vercuronium (neuro blocking agent)
20. One Albuterol Sulfate inhaler
21. Seven single use vials of Refresh eye drops

Staff C interviewed on 10/9/12 at 10:45am described the OR room as the main OR and described its use as routinely unused. Staff C unacknowledged the smaller OR room is frequently used and the unlocked anesthesia medication cart and the medications were available for anyone entering the unlocked unattended main OR room. Staff B interviewed on 10/10/12 at 1:00pm verified the two OR rooms are unattended 6 days of the week and the two medication carts were routinely unlocked in the OR and available to anyone entering the unlocked surgical suite.

The Critical Access Hospital (CAH) reported a census of 14 patients. Based on medical record review, staff interview and policy review the CAH failed to ensure the medical record contained a patient signed blood consent form for 1 of 1 patients (Patient #25) and a patient signed consent form for 1 of 3 patients who received outpatient antibiotic therapy (Patient #37).

Findings include:

- Document review on 9/9/12 of the CAH's "Standard Operating Policies and Procedures" titled, "Consent or Authorization for Medical and Surgical Treatment, date issued 11/4/03 directs staff to obtain a written consent by the patient before any medical and surgical treatment. Review of the policy title "Blood Transfusion" revised on 2/22/10 instructs staff to obtain the patient's consent for blood products.

- Patient #25 record review on 9/9/12 revealed an Emergency Room (ER) admit date of 9/18/12 with a diagnosis of hemorrhage of the gastrointestinal tract. The physician ordered a unit of red packed blood cells to be transfused. The record lacked a consent for the blood transfusion.

- Patient #37 record review on 9/9/12 revealed the physician ordered on 10/4/12 outpatient intravenous (IV) therapy Rocephin 1gram (gm) q (every) d (day) for 3 days. The record lacked a patient signed consent for treatment.

- Administrative staff F acknowledged patient #25's record lacked evidence of the consent for the blood transfusion and patient #37 record lacked evidence of a consent for the outpatient IV treatment.