HospitalInspections.org

Based on observation and staff interview(s) it was determined the hospital failed to ensure expired supplies were not available for patient use.

This had the potential to negatively affect all patients served by the facility.

Findings include:

1. An observation of the Emergency Department (ED) was conducted on 8/15/23 at 9:56 AM with Employee Identifier (EI) # 3, Swing Bed Coordinator.

During the observation, the following supplies were observed, expired and available for patient use in the ED:

a. One purple top laboratory (lab) tube which expired on 7/1/23.
b. Two Disposable Operating Room (OR) towels which expired on 6/23.
c. Five Neotrode ECG (electrocardiogram) electrodes which expired on 2/16/23.
d. Two 25 mm (millimeter) 15-gauge (G) needle sets which expired on 6/30/23.
e. Two Pediatric Colorimetric CO2 (Carbon dioxide) detectors which expired on 1/11/23.
f. Two 24 G 0.75-inch (") Intravenous (IV) catheters which expired on 6/30/23.
g. One 10 milliliter (ml) Luer-Lok tipped syringe which expired on 7/31/23.
h. One pediatric defibrillation pad which expired on 7/7/22.
i. Two 18 G 1.16" IV catheters which expired on 7/31/23.
j. Two 24 G 0.74" IV catheters which expired on 2/28/23.
k. One pair of size 7 sterile gloves which expired on 6/30/23.
l. One pair of size 7.5 sterile gloves which expired on 6/22.
m. One pair of size 8 sterile gloves which expired on 2/28/23.
n. One pair of size 8.5 sterile gloves which expired on 5/31/23.
o. Six IV start kits which expired on 3/1/23.
p. One incision and drainage tray which expired on 1/1/23.
q. One Central Venous Catheter kits which expired on 7/31/23.

During the tour EI # 3, verified the supplies were expired and available for patient use.

2. An observation of the Medical Surgical (Med Surg) Unit was conducted on 8/15/23 at 9:54 AM with EI # 8, Registered Nurse.

During the observation, the following supplies were observed, expired and available for patient use on the Med Surg Unit:

a. 34 bottles of 0.9% Sodium Chloride Injection 20 ml which expired on 5/1/23.
b. two 24 G 0.75" IV catheters which expired on 4/30/23.
c. six IV start kits which expired on 3/1/23.

During the tour EI # 8, verified the supplies were expired and available for patient use.

Based on review of MR (medical records) and staff interview, it was determined the staff failed to provide wound care per the physician orders.

This deficient practice did affect, two of twenty MR's reviewed, including MR # 6, and MR # 16 and had the potential to negatively affect all patients admitted to the hospital.


Findings include:

1. MR # 6 was admitted to the hospital on 7/20/23 with a diagnosis of Encounter of Orthopedic Aftercare following Surgical Amputation.

Review of the Physician's order dated 7/22/23 at 3:14 PM revealed an order for wound care to wounds "...covered by slough and or eschar- change foam dressing every other day: cleanse area with normal saline, pack with Hydrofiber, apply silicone bordered foam dressing."

Review of the nursing notes dated 7/22/23 to 7/27/23 revealed a wound # 1 Right Anterior Foot Diabetic Ulcer with full thickness tissue loss and "base is covered by slough and/or eschar..."

Review of the nursing notes dated 7/22/23 at 3:14 PM to 7/26/27 revealed no documentation wound care was provided to wound # 1 every other day as ordered.

Review of the nursing notes dated 7/27/23 at 6:10 PM revealed nursing documentation wound # 1 was cleaned with an antimicrobial agent, packed wet to dry with Vashe (brand of wound cleanser) moistened gauze. There was no documentation the wound care was provided as ordered.

Review of the nursing notes dated 7/28/23 at 6:48 PM revealed nursing documentation wound # 1 was cleaned with an antimicrobial agent and packed wet to dry with gauze. There was no documentation the wound care was provided as ordered.

Review of the nursing notes dated 7/29/23 at 6:33 PM revealed nursing documentation wound # 1 was cleaned with an antimicrobial agent, packed wet to dry with gauze and covered with rolled gauze. There was no documentation the wound care was provided as ordered.

Review of the nursing notes dated 7/30/23 at 6:47 PM revealed nursing documentation wound # 1 was cleaned with an antimicrobial agent and packed wet to dry with gauze. There was no documentation the wound care was provided as ordered.

An interview was conducted on 8/18/23 at 9:46 AM with EI # 2 who confirmed the staff failed to perform wound care per the physician's order.



41623

2. MR # 16 was admitted to the hospital on 8/3/23 with a diagnosis of Closed Displaced Intertrochanteric Fracture of Left Femur.

Review of the Nursing Progress Note dated 8/16/23 at 6:54 AM revealed the nurse documented the dressing to the left knee was changed, cast padding and elastic bandage applied.

Review of the physician's orders revealed no documentation of orders for wound care to the left knee.

An interview was conducted on 8/18/23 with EI # 2, who confirmed the dressing was changed without a physician's order.

Based on review of MR (medical records), hospital policy and staff interview, it was determined the facility failed to provide and document Physical Therapy (PT) and Occupational Therapy (OT) evaluations per the physician's order and hospital policy.

This deficient practice did affect MR # 4, MR # 8. and MR # 1, two of five inpatient MRs reviewed with PT and/or OT evaluation orders, and had the potential to negatively affect all patients who require PT and/or OT evaluation.

Findings include:

Hospital Policy Number: OCG.REHAB.OS.038
Title: Inpatient Evaluation
Effective Date: 6/2/21

Explanation: To outline the procedure for inpatient evaluation within the Rehabilitation Services Department.

General Instructions: An evaluation will be initiated upon physician...order. A patient's referral for therapy will be initiated within 48 hours of receiving physician...order... Evaluation results are to be documented in the electronic record.

1. MR # 4 was admitted to the hospital on 4/28/23 with a diagnosis of Generalized Weakness.

Review of the Physician orders dated 4/28/23 revealed an order for a PT and OT evaluation.

Review of the MR revealed no documentation of a PT and OT evaluation.

An interview was conducted on 8/18/23 at 9:58 AM with Employee Identifier (EI) # 2, Director of Nursing, who confirmed there was no documentation of a PT and OT evaluation.

2. MR # 8 was admitted to the hospital on 4/30/23 with diagnoses including Failure to Thrive in Adult and Community Acquired Pneumonia of Right Middle Lobe of Lung.

Review of the Physician orders dated 4/30/23 revealed an order for an PT evaluation.

Review of the MR revealed no documentation of a PT evaluation

An interview was conducted on 8/18/23 at 10:18 AM with EI # 2 who confirmed there was no documentation of a PT evaluation.



28327

3. MR # 1 was admitted to the hospital on 8/10/23 with a diagnosis of Acute Pyelonephritis.

Review of the Physician Orders dated 8/11/23 revealed an order for a PT and OT evaluation.

Review of the MR revealed no documentation of a PT and OT evaluation.

An interview was conducted on 8/18/23 at 10:00 AM with EI # 2, who confirmed there was no documentation of a PT and OT evaluation.

Based on review of MR (medical records), hospital policy and staff interview, it was determined the facility failed to provide and document wound care, and dietary consults per the physician's orders.

This deficient practice did affect MR # 5 and MR # 6, two of three inpatient MRs reviewed with wound care consults, and MR # 4, one of three inpatient MR's reviewed with dietary consults, and had the potential to negatively affect all patients admitted to the hospital.

Findings include:

Hospital Policy Number: OHS.NURS.OS.029
Title: Patient Care Consults
Effective Date: 12/19/22

...III. Standard.

A. Ochsner has an interdisciplinary approach to patient care, and in doing so, provides access to personnel with defined levels of expertise via consult.

B. ...Interdisciplinary team members who are available for consult...include the following:

1. Wound Ostomy Nurses...

9. Dietitians/Nutritionist...

1. MR # 5 was admitted to the hospital on 6/14/23 with a diagnosis of Muscle Weakness.

Review of the Physician orders dated 6/19/23 revealed an order for a wound care consult.

Review of the MR revealed no documentation a wound care consult was performed.

An interview was conducted on 8/18/23 at 9:57 AM with Employee Identifier (EI) # 2, Director of Nursing, who confirmed there was no documentation of a wound care consult.

2. MR # 4 was admitted to the hospital on 4/28/23 with a diagnosis of Generalized Weakness.

Review of the Physician orders dated 4/28/23 revealed an order for a Registered Dietitian/Nutritionist consult.

Review of the MR revealed no documentation of a Registered Dietitian/Nutritionist consult.

An interview was conducted on 8/18/23 at 9:58 AM with EI # 2 who confirmed there was no documentation of a Registered Dietitian/Nutritionist consult.

3. MR # 6 was admitted to the hospital on 7/20/23 with diagnoses including Encounter for Orthopedic Aftercare following Surgical Amputation and Bacteremia.

Review of the Physician orders dated 7/22/23 revealed an order for a wound care consult.

Review of the MR revealed no documentation of a wound care consult.

An interview was conducted on 8/18/23 at 9:46 AM with EI # 2 who confirmed there was no documentation of a wound care consult.

Based on observations, review of hospital policy and procedures, Manufacturer Directions for Use: Enzymatic Detergent, Steam Sterilizer Record Keeping logs, and interviews with the staff it was determined the facility failed to ensure:

a. Employees washed or sanitized hands per facility policy and procedure.

b. Staff disinfected vial (medication bottle) septum with an antiseptic prior accessing vial with needle.

b. Staff performed biological monitoring of the autoclave weekly per facility policy.

c. Staff followed the manufacturer's directions for use for Enzymatic Detergent when performing cleaning of surgical instruments.

This did affect 5 of 9 observations conducted at the facility and 1 of 1 review of the autoclave biological monitoring log and had the potential to affect all patients served by the facility.

Findings include:

Hospital Policy Number: CGH.IC.003
Title: Hand Washing and Hand Hygiene
Effective Date: 6/10/21

Purpose or Scope: Hand washing is the single, most effective means of preventing the spread of infection...

Procedure:

...When to wash your hands or use the alcohol-based hand rinse.

...c. Before having direct patient contact.

...h. After removing gloves.

Hospital Procedure: Sterility Assurance Program

Procedure:

For Prevac Steam Sterilizer:

...In addition to air removal testing, AAMI (The Association for the Advancement of Medical Instrumentation) standards recommend testing with a Biological Indicator (BI) test pack that is approved for the type of sterilization process being used. This should be done at least weekly but preferably daily.

Manufacturer Directions for Use (DFU): Enzymatic Detergent
Directions For Use

For Presoak and Manual Cleaning

1. Add 1/2 U. S. (United States) Fl (fluid) oz (ounce) of Enzymatic Detergent per 1 U.S. gallon...

1. An observation was conducted on 8/15/23 at 10:25 AM with Employee Identifier (EI) # 12, Registered Nurse (RN), to observe the administration of an Intramuscular injection.

During the observation, EI # 12 failed to perform hand hygiene prior to patient contact twice and once after gloves were removed.

An interview was conducted on 8/18/23 at 11:03 PM with EI # 2, Director of Nursing, who confirmed EI # 12 failed to follow the facility policy for hand hygiene.

2. An observation was conducted on 8/15/23 at 10:45 AM in the dietary department to observe plating of patient trays.

During the process of placing food items on the trays, EI # 10, Cook, dropped a blue rag onto the floor. EI # 10 picked up the rag with a gloved hand and placed it on the counter. EI # 10 failed to remove gloves and perform and hygiene after contaminating glove. EI # 10 proceeded to continue with the placement of food items on the trays.

After plating was completed, EI # 10 removed gloves and exited the kitchen area. EI # 10 failed to perform hand hygiene after removing gloves.

An interview was conducted on 8/18/23 at 10:05 AM with EI # 2, who confirmed the hospital policy for hand hygiene was not followed.

3. An observation of medication Intravenous (IV) administration was conducted on 8/15/23 at 1:48 PM with EI # 8, RN.

EI # 8 removed the cap from a vial of Piperacillin and spiked the vial with a Sodium Chloride diluent bag. EI # 8 failed to wipe the vial septum with an antiseptic prior to spiking.

After starting the antibiotic infusion, EI # 8 removed the gloves and exited the room to obtain a Sodium Chloride flush. EI # 8 failed to perform hand hygiene after removing gloves.

An interview was conducted on 8/18/23 at 10:05 AM with EI # 2, who confirmed the hospital policy for hand hygiene and IV medication administration was not followed.

4. An observation was conducted on 8/16/23 at 9:32 AM with EI # 13, RN, to observe Intravenous access placement.

During the observation, EI # 13 failed to perform hand hygiene after removing gloves twice.

An interview was conducted on 8/18/23 at 11:03 AM with EI # 2, who confirmed EI # 13 failed to follow the facility policy for hand hygiene.



41623




28327

-+5. A tour of the Central Sterile Department was conducted on 8/16/23 at 10:00 AM with EI # 8, RN and EI # 9, Sterile Processing Manager.

EI # 8 proceeded to demonstrate to the surveyor the cleaning process of the surgical instruments. EI # 8, stated, "I pump the handle of the Enzymatic Detergent 3 (three) times, which is about 90 cc (centimeters) to 1 (one) gallon water". EI # 9 then stated, "It should be 1/2 to 1 oz (ounce), which is 15 - 30 cc." EI # 8 failed to follow the DFU for Enzymatic Detergent when cleaning surgical instruments.

EI # 9 verified during the demonstration that EI # 8 failed the follow the DFU for Enzymatic Detergent when cleaning surgical instruments.

6. A review of the Steam Sterilizer Record Keeping logs for February to August 2023 revealed no documentation of weekly BI testing performed per facility policy the week of: 2/16/23, 2/23/23, 3/2/23, 3/9/23, 3/22/23, 3/29/23, 4/5/23, 4/12/23, 4/19/23, 4/26/23, 5/9/23, 5/16/23, 5/23/23, 5/29/23, 6/5/23, 6/12/23, 6/19/23, 6/26/23, 7/10/23, 7/24/23, 7/31/23, and 8/7/23.

An interview was conducted on 8/16/23 at 11:45 AM with EI # 9, who verified the staff failed to perform BI testing weekly per facility policy.