HospitalInspections.org

Based on record review and interview, it was determined that the hospital failed to evaluate the effectiveness of pain medication in a timely manner for 3 patients out of a survey sample of 53 patients. (Patient identifiers are: #4, #5, and #6.)

Findings include:

Review of the facility's "Pain Management [Ar#2-13]" policy on 12/6/16 with a revised date of 10/16, "Guidelines:..d. Re-assessment in all settings will occur with any new report of pain, prior to any pain relieving therapy, and within one hour of any pain relieving intervention."

Patient#4.
Interview on 12/6/16 with Staff B (Medical Records) and review of Patient #4's medical record revealed an order for "oxyCODONe 5 MG[milligram] = 1 tablet Oral Tablet Q3HPRN [every 3 hours when needed] moderate pain (4-6)". Review of the charted occurrence history revealed on 12/4/16 there is no documented pain reassessment of Patient #4 who received OxyCodone 5 MG within 60 minutes as required by the hospital policy, OxyCodone 5 MG was administered at 01:09 and the pain reassessment was documented at 04:03.

Review on 12/4/16 of the charted occurrence history revealed there is no documented pain reassessment of Patient #4 who received OxyCodone 5 MG within 60 minutes as required by the hospital policy, OxyCodone 5 MG was administered at 18:36 and the pain reassessment was documented at 20:55.


Patient#5.
Interview on 12/6/16 with Staff B and review of Patient #5's medical record revealed an order for "oxyCODONe 10 MG = 1 tablet Oral Tablet Q4HPRN moderate pain R[right] Flank/Rib Pain..."Review of the charted occurrence history revealed on 12/6/16 there is no documented pain reassessment of Patient #5 who received OxyCodone 10 MG within 60 minutes as required by the hospital policy, OxyCodone 10 MG was administered at 01:10 and the pain reassessment was documented at 03:19.

Review on 12/5/16 of the charted occurrence history revealed there is no documented pain reassessment of Patient #5 who received OxyCodone 10 MG within 60 minutes as required by the hospital policy, OxyCodone 10 MG was administered at 08:47 and the pain reassessment was documented at 11:59.

Review on 12/5/16 of the charted occurrence history revealed there is no documented pain reassessment of Patient #5 who received OxyCodone 10 MG within 60 minutes as required by the hospital policy, OxyCodone 10 MG was administered at 14:00 and the pain reassessment was documented at 16:24.

Review on 12/7/16 of the charted occurrence history revealed there is no documented pain reassessment of Patient #5 who received OxyCodone 10 MG within 60 minutes as required by the hospital policy, OxyCodone 10 MG was administered at 09:37 and the pain reassessment was documented at 11:00.

Patient#6.
Interview on 12/6/16 with Staff B and review of Patient #6's medical record revealed an order for "Acetaminophen (Tylenol) 650 MG = 2 Tablet Oral Tablet Q6HPRN Mild Pain (1-3)". Review of the charted occurrence history revealed on 12/6/16 there is no documented pain reassessment of Patient #6 who received Acetaminophen 650 MG within 60 minutes as required by the hospital policy, Acetaminophen 650 MG was administered at 12:01 and the pain reassessment was documented at 14:44.

Based on record review and interview, it was determined that the facility failed to document a discharge order for one patient, in a survey sample of 53 patients. (Patient identifier is #52.)

Findings include:

Review of Patient #52's medical record was facilitated by 3 hospital navigators including Staff F (Patient Care Services) and Staff E (Care Coordination), and revealed that Patient #52 was admitted for acute stay to the facility on 11/19/16, and was subsequently admitted to swing bed status on 11/25/16. Facility navigation identified in the medical record "Swing/Skilled Level of Care as of 11/25/2016..." However, the facility was unable to identify in the record an order discharging the resident on 11/25/16 from their acute hospital stay.

Based on observation and interview, it was determined that the hospital failed to secure drugs and biological's to prevent unmonitored access by unauthorized individuals.

Findings include:

Observation on 12/5/16 during initial tour of the Emergency Department showed that the Hospital failed to secure and lock drugs and biological's from access by unauthorized persons. Observed was an unlocked, unattended mobile cart identified by Staff A (Registered Nurse) as a difficult intubation cart. This cart contained a unopened bottle of Lidocaine, two unopened medication spray bottles and multiple individual sterile wrapped #10 and #15 scalpels. On top of this cart was a container with multiple individual sterile wrapped disposable sterile 10 cc syringes.

Interview on 12/5/16 at the time of tour with Staff A confirmed the above observation.

Based on observation and interview, the hospital failed to prevent outdated Xylocaine from being available for patient use in 1 of 16 outpatient practices visited.

Findings include:

Observation on 12/6/16 at 1:05 p.m. on tour of the ear, nose, and throat practice, revealed an open multiuse vial of Xylocaine with an open expiration date of 12/2/16.

Interview on 12/6/16 at 1:05 p.m. with Staff D (Director of Ambulatory Services) confirmed the above finding and revealed the hospital labels multiuse vials with an expiration date of 28 days when they first enter the bottle.

Based on record review and interview, the hospital failed to check personnel in the operating room, who are routinely exposed to radiation, periodically for the amount of radiation exposure by use of badge tests

Findings include:

Review on 12/7/16 of the dosimetry badge reports for 2016 revealed badges labeled C-ARM. The reports did not have dosimetry badge reports for operating room staff.

Interview on 12/7/16 at 1:20 p.m. with the Staff B (Radiology Technologist) confirmed that in the operating room, they put a badge on the C-ARM instead of personnel in the operating room exposed to radiation during C-ARM usage.

Based on record review and interview, it was determined that the facility failed to develop policies that comprehensively addressed procedures to prohibit mistreatment, neglect, and abuse of residents and misappropriation of resident property.

Findings include:

Review of the facility's policy "Cheshire Medical Center Swing Bed Program" dated 6/15 identifies that the facility has a swing bed program and that "The Director of Inpatient Services is the full-time administrator responsible for the overall management of the Swing bed program. They are responsible for developing and maintaining the philosophy and objectives for the Swing Bed Program, standards of practice, policies and procedures, ...."

Review of the facility's written policies to prohibit mistreatment, neglect, and abuse of residents and misappropriation of resident property, reveals a policy last revised 9/16 titled "DOCUMENT: Victims of Alleged or Suspected Abuse (Physical or Emotional), Neglect, Domestic Violence and/or Sexual Assault (Children, Elderly, Disabled, Sexual Assault & Domestic). The section on Reporting Requirements does not address that all alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown source, and misappropriation of resident property must be reported immediately (and the results of all investigations within 5 working days) to the administrator of the facility and to other officials in accordance with State law through established procedures (including to the State survey and certification agency).

Review of the facility's "EMPLOYMENT PRACTICES" policy (revised March 2014) and "PRE-PLACEMENT SCREENING POLICY" (dated April 2012) reveals that the hiring process includes background and reference checks; however, the policies do not mandate that the facility must not employ individuals who have been found guilty of abusing, neglecting, or mistreating residents by a court of law; or have had a finding entered into the State nurse aide registry concerning abuse, neglect, mistreatment of residents or misappropriation of their property.

During interview(s) on 12/7/16, swing bed regulations were reviewed with Staff E (Care Coordination) and/or Staff F (Inpatient Services), seeking information and facility documentation to establish the facility's compliance or noncompliance with the applicable requirements. Additional interview(s) on 12/7/16, with facility staff (Staff H) and Staff I (Human Resource) established verbally that the facility does check the N.H. nurse aide registry before or on the day of hire, and if received on day of hire and it was fraud, abuse, neglect the person would be fired.