HospitalInspections.org

Based on a review of facility documents, medical record review (MR) and staff interview (EMP), it was determined the facility failed to assess a patient for potential injury following self-inflicted harm for one of one applicable medical record reviewed (MR1).

Findings include:

A request was made for a copy of the facility policy, procedure or guideline facility staff follow for assessing patients following self- inflicted injury. None was provided.

Review of MR1 on October 4, 2016, revealed this patient was admitted to the facility's Emergency Department on August 19, 2016, on a 302 (involuntary commitment for mental health evaluation) commitment. Further review revealed nursing documented MR1 was punching self with open and closed fists repeatedly in the face, nose and head and MR1 self-banged head against the wall.

There was no documentation in MR1 indicating nursing staff assessed MR1's face and head for signs and symptoms of injury including redness, bruising, cuts and scratches, bumps and bruises and broken bones following this patient's punching self with open and closed fists repeatedly in the face, nose and following MR1's banging head against the wall.

Interview with EMP1, EMP2, EMP3 and EMP4 on October 4, 2016, at approximately 2:00 PM confirmed there is no documentation in MR1 indicating nursing staff assessed MR1's face and head for injury following this patient's punching self with open and closed fists repeatedly in the face, nose and head and banging head against the wall. EMP1, EMP2, EMP3 and EMP4 revealed it is expected nursing practice to assess a patient for signs and symptoms of injury including redness, bruising, cuts and scratches, bumps and bruises and broken bones following any attempts at harming themselves.

Based on a review of facility documents, observation and staff interview (EMP), it was determined the facility failed to ensure a safe and sanitary environment in the facility's Emergency Department.

Findings include:

Review on October 4, 2016, of the facility's "Cleaning the Emergency Department" policy, last approved August 18, 2016, revealed "Purpose: The purpose of this policy is to clarify the procedure for providing Environmental Services to the Emergency Department. Policy: ... 4. Emergency Department staff will be responsible for the following items: all clinical equipment, keeping all work areas neat and organized, cleaning scrub sinks and work counters aw needed and at the end of each shift, and keeping medical and clerical supplies stocked and organized. ... ."

Observation tour of the Emergency Department (ED) on October 4, 2016, revealed patient room 33 ready for patient use. Further observation revealed a 2 inch long piece of white fluffy material hanging from the ceiling vent directly above the stretcher and a hole in the wall measuring approximately 3 inches wide and 1 inch deep.

Interview with EMP3, EMP4 and EMP5 on October4, 2016, at approximately 10:00 AM confirmed the 2 inch long piece of white fluffy material hanging from the ceiling vent directly above the stretcher and the hole in the wall measuring approximately 3 inches wide and 1 inch deep. Further interview with EMP3 and EMP4 confirmed there is potential for this piece of white fluffy material to become dislodged from the vent and land in a patient's open wound causing an infection.

Observation tour of the ED on October 4, 2016, revealed Trauma Room 2 ready for patient use. Further observation revealed two ceiling mounted lights directly over the patient stretcher. Continued observation revealed white gray dust on the top and bottom of both lights measuring approximately a twenty five cent piece when gathered together, white gray dust on the adjustable arms of both lights measuring approximately a fifty cent piece when gathered together. There was also a ceiling mounted portable x-ray machine with black dust on all the horizontal flat surfaces and corners of the machine.

Interview with EMP3, EMP4 and EMP5 on October 4, 2016, at approximately 10:45 AM confirmed the two ceiling mounted lights directly over the patient stretcher in Trauma Room 2 with white - gray dust on the top and bottom of both lights measuring approximately a twenty five cent piece when gathered together the white - gray dust on the adjustable arms of both lights measuring approximately a fifty cent piece when gathered together and the ceiling mounted portable x-ray machine with black dust on all the horizontal flat surfaces and corners of the machine.

Observation tour of the ED on October 4, 2016, revealed a seclusion room ready for patient use. Further observation revealed a thick blue string in the middle of the floor measuring approximately 3 feet long; dirt, dust and brown debris along the entire parameter of the room and a tear in the mat measuring approximately 4 inches long.

Interview with EMP3, EMP4 and EMP5 on October 4, 2016, at approximately 11:00 AM confirmed the thick blue string in the middle of the floor measuring approximately 3 feet long; dirt, dust and brown debris along the entire parameter of this room and a tear in the mat measuring approximately 4 inches long.