HospitalInspections.org

Based on observation, interview and document review, the critical access hospital (CAH) failed to ensure emergency supplies and equipment had not expired and were available for use in 2 of 3 emergency equipment carts.

Findings include:

Observation of the Emergency Department (ED) on 3/18/24 at 2:05 p.m., revealed the pediatric crash cart (nine drawer color coded cart) with the contents included an endotracheal tube (ETT) (keep the airway open in order to give oxygen, medicine, or anesthesia), stylet (adjust the curve of an endotracheal tube in order to make insertion easier), suction catheter, laryngoscope (a thin tube with a light, lens and a video camera that helps providers look closely at your larynx), bag valve mask, oral airway, nasal airway, laryngeal mask airways (LMA) (temporary method to maintain an open airway during the administration of anesthesia or as an immediate life-saving measure), oxygen mask, urinary catheter, nasogastric tube, vascular access and blood pressure cuff. The gray drawer had an expiration date of 2/14/24, and was secured. The pink/red drawer had an expiration date of 2/11/24, and was secured. The purple drawer had an expiration date of 2/1/24, and was secured. The white drawer had an expiration date of 2/28/24, and was secured. The green drawer had an expiration date of 2/4/24, and was secured.

An observation on 3/18/24 at 2:30 p.m., revealed the respiratory cart in the trauma room had a drawer with Miller blades (straight blade for the laryngoscope designed to obtain a view of the vocal cords) and Macintosh blades (curved blades for the laryngoscope) had an expiration date of 2/24. The drawer containing anesthesia masks, end tidal CO2 detectors (carbon dioxide detectors help verify endotracheal tube placement), CO2 colorimetric indicator (confirm proper ETT placement by assessing exhaled CO), suction, gastric tube had an expiration date of 2/24.

An interview on 3/18/24 at 2:20 p.m., with registered nurse (RN)-A stated the nurse assigned to check the carts left last month and the cart checks had not been reassigned to any other nurse after she left. RN-A stated someone should have been checking the pediatric crash cart and respiratory cart for expiration dates.

A facility policy was requested however was not received.

Based on observation, interview and document review, the critical access hospital (CAH) was found to be out of compliance with Life Safety Code requirements. These findings have the potential to affect all patients in the hospital.

Findings include:

Please refer to the Life Safety Code inspection tags: K0281, K293, K0353, K0712, K0761, K0918 and K0920 for additional information.

Based on observation, interview and document review, the Critical Access Hospital (CAH) failed to ensure the procedure to ensure food served to patients was cooked to a safe temperature to prevent food-borne illness. This had the potential to affect all patients being served food from the kitchen.

Findings include:

During a kitchen tour on 3/18/24 at 5:06 p.m., cook (C)-B stated the temperatures for foods had not been recorded for the evening meal and added the food temperatures had not been recorded on a regular basis for the month of March 2024. C-B indicated he had not recorded food temperatures for the evening meal. C-B reviewed the three ring binder with the food temperatures and stated that no food temperatures had been recorded since 3/10/24.

Review of the Food Temperature logs from 2/25/24 to 3/18/24, revealed the following:

2/25/24, no temperatures recorded for the evening meal.
2/26/24, no temperatures recorded breakfast and evening meal.
3/2/24, no temperatures recorded for any meals.
3/3/24, no temperatures recorded for any meals.
3/5/24, no temperatures recorded for the evening meal.
3/6/24, no temperatures recorded for any meals.
3/7/24, no temperatures recorded for any meals.
3/8/24, no temperatures recorded for any meals.
3/10/24, no temperatures recorded for the evening meal.
3/11/24, no temperatures recorded for any meals.
3/12/24, no temperatures recorded for any meals.
3/13/24, no temperatures recorded for any meals.
3/14/24, no temperatures recorded for any meals.
3/15/24, no temperatures recorded for any meals.
3/16/24, no temperatures recorded for any meals.
3/17/24, no temperatures recorded for any meals.
3/18/24, no temperatures recorded for breakfast and lunch.

During an interview on 3/19/24 at 1:33 p.m., registered dietician (RD)-D stated she would expect dietary staff to record the temperatures of food when they were removed from the stove or the oven to ensure they were at a safe temperature to serve to prevent any food borne illnesses.

During an interview on 3/20/24 at 8:34 a.m., the director of nursing (DON) stated she would expect dietary staff to follow the procedure to ensure foods were cooked to a safe temperature.

Taking/Recording Food Temperatures dated 11/5/21, identified the following "Nutritional Services staff will take and record temperatures of all food prior to serving". The purpose as identified in the policy was to ensure food safety.

Based on observation, interview and document review, the critical access hospital (CAH) failed to ensure transmission based precautions (TBP) were followed which included the use of personal protective equipment (PPE)
to prevent the potential spread of infection for 1 of 4 patients (P5) observed for TBP.

Findings include:

Observation on 3/19/24 at 11:30 a.m., P5's room door was closed and a brightly colored sign posted at eye level was noted on the door. The sign was bright blue with a red stop sign that listed "check with nurse before entering". The sign identified Droplet precautions (necessary when a patient has an infection that can be transmitted by talking, coughing, and/or sneezing). The sign identified a mask was required for staff and visitors and directed visitors to check with nursing for mask instructions.

Observation on 3/19/24 at 12:18 p.m., family member (FM)-A walked past nursing station, down the hall, past the director of nursing (DON), walked to P5's room, looked at the eye level sign, opened the door and entered without applying PPE. The DON was asked if FM-A was expected to apply a mask prior to entering P5's room and she replied she thought she had spoken to FM on 3/18/24, about the required use of PPE. The DON donned PPE and entered P5's room. Three visitors were present in the room with P5 and none of them were wearing a mask. All three visitors stated they were not aware of the need to use PPE and indicated they had been in and out of P5's patient room multiple times over the past two days, spoken to unidentified nursing staff and had not received any education related to the need to use PPE.

Interview on 3/19/24 at 12:20 p.m., FM-A stated she had not received any education on the need to wear a mask or perform hand hygiene upon entering and exiting patient rooms. In addition, FM-A indicated she had accompanied P5 when he was seen in the emergency department prior to admission and when P5 had first been seen in the clinic and stated no education had been provided to her regarding the use of PPE. FM-A stated the family had celebrated P5's birthday and brought a cake on 3/18/24, which they had shared with another patient and nursing staff on duty.
FM-A indicated she had also been in P5's room on 3/19/24, when an unidentified staff member had entered P5's room, without wearing a mask, gone to his bedside, worked with the computer, provided cares and exited the room.

Interview on 3/19/24 at 12:20 p.m., the DON stated her expectation was for staff and visitors to follow the Essentia Infection Control policies and procedures and nursing staff should have provided education on transmission-based precautions (TBP's) to any visitors prior to them entering P5's room. DON indicated she needed to provide additional infection control education to staff due to the lack of providing education which could have resulted in potential infectious exposure to staff and other residents.

Interview on 3/19/24 at 2:04 p.m., the physician assistant (PA)-A stated she had not been aware P5 was on droplet precautions until after she entered the room and accessed the electronic medical record (EMR). PA-A indicated she had exited the room and obtained a mask once she realized P5 was in precautions. PA-A stated the room door was open and she had not noticed the sign posted on the door prior to entering. PA-A indicated her expectation for both staff and visitors was to follow posted signage for precautions which included PPE use. PA-A confirmed the sign was posted on the outside of P5's room door at eye level, however she had not noticed it and entered P5's room without donning a mask.

Interview on 3/20/24 at 10:31 a.m., the Fosston Infection Practioner (IP) identified when a patient required TBP, the physician documented an order for isolation precautions in the chart. IP stated it was then the responsibility of the nursing staff to implement precautions, place signage on the room door and provide education to the patient, visitors and staff. IP indicated the education provided should have been documented in the patient's medical record and included in the care plan.

Review of the facility policy titled Essentia Health Droplet Precautions dated 2/22/24, identified infectious particles were spread in the air during coughing, sneezing or during a respiratory procedure. The contaminated droplets could have been propelled through the air from two to 10 feet depending on the force of the cough or sneeze. Respiratory protection were required for staff or visitors when entering the patient room. Education to visitors was to include review of isolation procedures, limiting visitors, hand hygiene upon entry and exit of the room, and wearing of a mask while in the patient room.

Based on interview and document review, the critical access hospital (CAH) failed to install and maintain generators per NFPA 99 (2012 edition), Health Care Facilities Code, section 6.4.4.1.1.3, 6.4.1.1.16.2 and 6.4.1.1.17, and NFPA 110 (2010 edition), Standard for Emergency and Standby Power Systems, sections 8.4.9, 8.4.9.1, 8.4.9.2 and 8.4.9.5.1. These deficient findings could have a widespread impact on the residents within the facility.

Findings include:

On 3/19/24 between 12:00 p.m. and 4:00 p.m., it was revealed by a review of available documentation of the emergency generator maintenance and testing that the facility could not provide documentation that a 36 month four (4) hour load bank test had been performed.

An interview with the Maintenance Director verified these deficient findings at the time of discovery.