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Based on observation and interview, the hospital failed to develop and post their nurse staffing plan, staffing schedule, and staffing for each shift according to Washington state law.

Reference:

RCW 70.41.420 - Nurse Staffing Committee
(7) Each hospital shall post, in a public area on each patient care unit, the nurse staffing plan and the nurse staffing schedule for that shift on that unit, as well as the relevant clinical staffing for that shift. The staffing plan and current staffing levels must also be made available to patients and visitors upon request.

Findings:

On 1/10/2012, observations in the hospital's acute care unit, obstetrical unit, and emergency department revealed that the hospital had not posted nurse staffing plans, staffing schedules and current staffing levels as required by the RCW.

An interview with the Director of Patient Care Services on 1/10/2011 at 12:30 PM confirmed that this information had not been posted.

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Based on observation and interview, the critical access hospital failed to prevent cross-connections in the potable water supply.

Failure to prevent cross-connections in the potable water supply risks sewage contamination of sanitary food preparation surfaces.

Findings include:

During a tour of the critical access hospital on 01/11/2012 it was observed that a multiple-compartment sink in the hospital kitchen was not provided with air-breaks in the sewage drain lines. The hospital dietary manager stated that the sinks were used for ware washing, and baking sheets were observed in the sinks.

The hospital facilities manager confirmed the observations.

Based on interview and record review, the critical access hospital failed to formalize and document the process to suspend clinical privileges when a provider was suspected of potentially unsafe practice.

Failure to formalize and document the emergency suspension of provider privileges risks uncertainty about whether a provider may continue to practice in the hospital.

Findings include:

During review of critical access hospital medical staff credentialing records on 01/11/2012, it was noted that the record for 1 of 10 providers contained a memo that provider #MD1 was "released from duty..."

In an interview on the same date, the hospital administrator described nursing staff concerns regarding MD1's mental health.

There was no documentation in MD1's credentialing record that formal action had been taken by the hospital in accordance with the Medical Staff Bylaws, or that formal notice had been given to MD1 of his/her status regarding privileges at the hospital.

Based on observation and interview, the hospital failed to ensure medications for anesthesia were provided according to accepted standards of practice as demonstrated by 1 of 2 anesthesia providers observed (Anesthesia Provider #1).

Failure to provide medications for anesthesia in accordance with accepted standards of practice risks medication errors and transmission of communicable diseases to patients.

References: "Safe Injection Practices to Prevent Transmission of Infections to Patients" (Centers for Disease Control and Prevention; April 2011); "APIC Position Paper: Safe Injection, Infusion, and Medication Vial Practices in Health Care" (Association for Professionals in Inection Control and Prevention; 2010); ASA Statement on the Labeling of Pharmaceuticals for Use in Anesthesiology (American Society of Anesthesiologists, October 2009)

Findings:

1. On 1/11/2012, Surveyor #1 observed Anesthesia Provider #1 in the pre-operative care area. Anesthesia Provider #1 had two pre-filled medication syringes in the pocket of his scrubs. One syringe of clear fluid was labeled "Fentanyl". The other syringe of white fluid was not labeled.

When interviewed at that time, Anesthesia Provider #1 stated that the syringe of white fluid contained the anesthetic agent diprovan. The provider stated that s/he routinely withdrew multiple doses of the medication for multiple patients from one diprovan vial.

2, Diprovan is dispensed in single patient vials which have no preservatives. The Centers for Disease Control and Prevention guidelines for Safe Injection Practices state that single patient vials hould not be used for multiple patients. Doing so risks transmission of communicable diseases between patients.

The Association for Professionals in Inection Control and Prevention states that syringes of medications should not be placed in the pockets of healthcare providers. Doing so risks contamination of the medication within the syringes.

The American Society of Anesthesiologists states that consistency and clarity of pharmaceutical and syringe labeling are important elements in prevention of medication errors made by anesthesia providers.



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