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Based on observation and staff interview the facility failed to ensure for patients at Shands Rehabilitation Hospital privacy during medication administration.

Findings:

During tour of Shands Rehabilitation Hospital on 01/05/2012 at 8:30 AM revealed a "Computer on Wheels" in the patient dining room.

Interview with the Unit Manager on 01/05/2011 at 8:30 AM revealed the Computer on Wheels is used for medication administration. When asked if medications were administered in the dining room the Unit Manager stated that medications were routinely administered to patients in the dining room. When asked if the nurse obtained the patient's permission prior to administering medications she stated that permission was not obtained.

Based on record review and interview the hospital failed to ensure that 2 (#16 and #19) of 37 patients reviewed had complete and authenticated medical records.


Findings:

1.) During record review for Patient #16 it was revealed the the patient was admitted for cardiac diagnostic testing on 10/21/11. On 10/26/11 the patient was scheduled for a surgical procedure. Review of the consent dated 10/25/11 at 10 AM the patient signed the consent for an "Aortic Valve replacement, mitral valve replacement, possible coronary artery bypass and indicated procedures." The surgeon signed the consent on 10/26/11 certifying that he had discussed the risks and benefits to the patient. There was no time indicating that this information was provided prior to the surgical procedure.

On 10/26/11 at 6 PM Patient #1 received a unit of blood. There is no signature listed on the blood slip on the line titled "transfusion ended by."

On 10/26/11 at 7:17 PM Patient #1 received a unit of blood. There is no signature listed on the blood slip on the line titled "transfusion ended by."

On 10/26/11 at 9:28 PM Patient #1 received a unit of blood. There is no signature listed on the blood slip on the line titled "transfusion ended by."

On 10/26/11 at 8:25 PM Patient #1 received a unit of blood. There is no signature listed on the blood slip on the line titled "transfusion ended by."

On 10/26/11 at 9:38 PM Patient #1 received a unit of blood. There is no signature listed on the blood slip on the line titled "transfusion ended by." The line titled "did a transfusion reaction occur was also left blank.

There were 2 blood slips and 2 pooled platelet slips for Patient #1 that did not contain the date and time the transfusion started or ended. There is no signature listed on the blood slip on the line titled "transfusion ended by." The" volume given" and "did a transfusion reaction occur" lines were also left blank.

Interview with the Quality Management Team on 1/6/12 at 9:45 AM stated that all of the blood slips that were scanned into the computer indicated that the units had been transfused to the patient.

Review of the hospital policy titled "blood product administration dated April, 2011 page 8 B 3 "initiating transfusions" states to 'document start date and time." Line C 2 "completed transfusions" states to "record stop time, record adverse reactions, calculate infusion volume and complete blood product tag and place in patient's chart."


2. During record review for Patient #19 it was revealed the the patient was admitted on 10/28/11 for an esophagogastroscopy with biopsy. There was a consent signed by the patient and the surgeon on 10/28/11. There were no times indicating when the consent was signed by the patient or the physician.

Interview with the Director of Health Information Technology on 1/6/12 at 9:15 AM she stated that there was no system in place for the physicians to authenticate the medical record after it is scanned into the computer.

Interview with the Director of Quality Management on 1/6/12 at 11:30 AM she stated that the physicians are to authenticate there signatures at the time the document is signed. The physicians are not allowed to authenticate there signatures after the fact. She stated that there are no policies dealing with authentication of medical records.

Based on observation and interview the hospital failed to maintain the dialysis recliners in good repair in a manor that would protect patients from skin tears and/or protect patients from an infection control risk.

Findings:

During a tour of the dialysis in-patient unit on 1/4/12 at 8:27 AM with the nurse manager it was noted that there were 2 chairs with 1-1 1/2 inch tears in the arm of upholstery. A patient was observed receiving a dialysis treatment in one of the chairs. The other chair was in a back hall area. There was no sign on the chair indicating that it was not to be used.

Interview with the nurse manager on 1/4/12 at 8:27 AM stated that she reported the chairs to maintenance for repairs. She also stated that the other chair was out of service.

Telephone interview with the Quality Management Director on 1/9/12 at 11:45 AM the surveyor requested the repair work order for the chairs and the policy for turn around times for repair of patient furniture.

The requested items had not been received at the time of this writing.

Based on observation, interview and record review the hospital failed to ensure the enforcement of the Infection Control policies and procedures.
FINDINGS:
An observation was made on 01/05/2012 at 11:28 AM of a Patient Care Assistant (PCA) performing an Acucheck (glucose monitoring) on a patient in a room with a sign " Contact VRE " precautions. The PCA left the room without washing her hands and applied hand sanitizer to her hands. The PCA then went to another patient ' s room do another Acucheck.
A review of the medical record revealed the hospital progress note dated 12/19/2011 stated the doctor was notified of patient stool result, positive for C-diff and the patient was started on Metronidazole 500 mg by mouth every 8 hours. The progress note stated " patient placed on enteric precautions per MD ' s order " . The discharge note from the hospital listed C-diff as a diagnosis on 12/26/2011. The MAR revealed the patient was taking the Metronidazole through 01/04/2012.
The review of the policy on Enteric precautions revealed " Hand Hygiene-Necessary before entering patient ' s room, as appropriate and during patient care. Hands must be washed with an antimicrobial agent soap and water to remove any spores(C-difficile), since spores are not killed or removed by alcohol and rubs. Room- Signs appropriate to the type of isolation (Enteric Precautions) must be placed on the outside of the patient ' s door " .
On 01/05/2012 at 1:15 PM an interview was conducted with the PCA. She stated she received infection control training twice. The PCA meeting on 01/04/2012 covered infection control. She stated she knew what she did wrong earlier and can ' t use gel for C-diff, would have to wash hands.
On 01/06/2012 and interview with the Infection Control Practitioner for the hospital was conducted. He stated the hospital gives C-diff education using CDC guidelines and includes enteric precautions. The education also includes soap and water on exiting the room.

Based on record review and interview the hospital failed to ensure that 2 (#16 and #19) of 37 patients received properly executed informed consent prior to a non-emergency surgical procedure.

Findings:

1.) During record review for Patient #16 it was revealed the the patient was admitted for cardiac diagnostic testing on 10/21/11. On 10/26/11 the patient was scheduled for a surgical procedure. Review of the consent dated 10/25/11 at 10 AM the patient signed the consent for an "Aortic Valve replacement, mitral valve replacement, possible coronary artery bypass and indicated procedures." The surgeon signed the consent on 10/26/11 certifying that he had discussed the risks and benefits to the patient. There was no time indicating that this information was provided prior to the surgical procedure.

2. During record review for Patient #19 it was revealed the the patient was admitted on 10/28/11 for an esophagogastroscopy with biopsy. There was a consent signed by the patient and the surgeon on 10/28/11. There were no times indicating when the consent was signed by the patient or the physician.

Interview with the Director of Health Information Technology on 1/6/12 at 9:15 AM she stated that there was no system in place for the physicians to authenticate the medical record after it is scanned into the computer.

Interview with the Director of Quality Management on 1/6/12 at 11:30 AM she stated that the physicians are to authenticate there signatures at the time the document is signed. The physicians are not allowed to authenticate there signatures after the fact. She stated that there are no policies dealing with authentication of medical records.