HospitalInspections.org

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Based on observation and interview, the Critical Access Hospital failed to 1) ensure that emergency department staff members were trained and competent regarding use of a portable suction unit located in the hospital's emergency department, as demonstrated by 5 of 5 staff members reviewed (Staff #2, #3, #4, #5, #6); and 2) develop and implement a policy and procedure to ensure that nurses verified that the portable suction machines located in the hospital's emergency department and respiratory therapy equipment storage closet were functioning and ready for use.

Failure to ensure hospital staff members are trained and competent regarding emergency response procedures and use of equipment risks delay of patient care during medical emergencies, which can result in patient harm and death.

Failure to ensure that emergency equipment is functioning and ready for use risks delay of patient care during medical emergencies, which can result in patient harm and death.

Findings included:

ITEM #1 - ED TRAINING AND COMPETENCIES

1. On 09/11/19, the investigator reviewed the medical records of Patient #1, who was treated in the hospital's emergency department on 09/01/19. Shortly after the patient's arrival at 11:50 PM, the patient experienced respiratory arrest. At 12:00 AM an emergency department physician placed an endotracheal tube (ET) into the patient's trachea, and a respiratory therapist provided artificial respiration via the ET tube with a self-inflating bag resuscitator. Notes in the patient's record read that a nurse (Staff #2) was "preparing suction portable" at 12:03 AM and "Suction portable in room - working" at 12:14 AM.

2. On 09/11/19 at 10:15 AM during an interview with the investigator, the nurse (Staff #2) stated that she was not familiar with the portable suction machine used to treat Patient #1 on 09/01/19 and had not been trained to use it. This delayed preparation and delivery of the machine to the patient's bedside.

3. On 09/11/19 at 4:30 PM, the investigator reviewed the training and competency records for four other nurses who worked in the emergency department. The records did not include evidence that the nurses were trained and deemed competent in the use of portable suction equipment.


ITEM #2 - EMERGENCY EQUIPMENT READINESS CHECKS:

1. On 09/11/19 at 10:30 AM, the investigator interviewed a registered nurse working in the hospital's emergency department (ED) (Staff #2). During the interview, the investigator reviewed the ED's process for verifying that emergency equipment was available, functioning, and ready for use. The interview and review of the "Daily Code Cart Checklist" log showed that the verification process did not include checking the portable suction unit located in Trauma Room #1 and three portable suction units located in the respiratory therapy equipment storage closet.

2. Review of the hospital's policy and procedure titled, "Code Cart Readiness and Maintenance Policy and Procedure," Policy #375 dated 06/20/19, showed emergency equipment and supply carts ("code carts") would be checked daily. The code cart checks included checking the defibrillator, medication expiration dates, and self-inflating (Ambu) bag resuscitator and mask. The checks did not include checking the portable suction units.
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