HospitalInspections.org

Based on medical record review, staff interview and review of the facility's policy it was determined the Registered Nurse failed to ensure the patient's pain level was assessed prior to an intervention and failed to reassess the patient's pain level following an intervention for two (#11, #16) of thirty four patients sampled. The Registered Nurse failed to ensure a care plan was reviewed and/or updated for one (#15) of thirty four patients sampled. The Registered Nurse failed to ensure physician orders were performed in a timely manner for one (#10) of thirty four patients sampled. This practice does not ensure patient's goals are achieved and may lead to a prolonged hospital stay.

Findings include:

1. Patient #11 was admitted on 5/4/2012 with a diagnosis of left hip fracture. Review of the physician orders dated 5/5/2012 at 3:10 p.m. revealed an order for Norco 5/325 mg (milligrams) 1-2 tablets by mouth every 4 hours as needed for pain. Review of the MAR (Medication Administration Record) revealed on 5/8/2012 at 5:30 a.m. the patient received one Norco. Review of the nursing documentation revealed no evidence of the patient's pain level prior to the administration of the medication for pain and no assessment of the patient's pain level following administration of the Norco.

Review of the facility policy, "Pain Management", last revised 3/2010, stated if pain was present, the patient's self report of pain (using a standard scale, such as 0-10) will be documented and used to guide intervention and to measure relief obtained. The policy stated appropriate follow up will include obtaining the patient's pain score following pharmacological or non-pharmacological intervention. This time frame for follow-up will not exceed 60 minutes.

Interview with the RN and the Manager of Quality on 5/8/2012 at 11:00 a.m. confirmed the above findings.

2. Patient #16 was admitted on 4/24/2012 with a diagnosis of Pneumothorax. Review of the physician orders dated 4/24/2012 revealed an order for Percocet 5/325 mg 1-2 tablets by mouth every 6 hours as needed for pain. Review of the MAR revealed on 4/25/2012 at 5:28 a.m. the patient received one Percocet. Review of the nursing documentation revealed no evidence of the patient's pain level prior to the administration of the medication for pain and no assessment of the patient's pain level following administration of the Percocet.

Review of the MAR dated 5/7/2012 revealed the patient received 2 Percocet at 12:09 a.m. Review of the nursing documentation revealed no documentation of the patient's pain level prior to the administration of the Percocet.

Interview with the RN and Nurse Manager on 5/7/2012 at 11:30 am confirmed the above findings.

3. Patient #15 was admitted on 5/3/2012 with a diagnosis of Hydronephrosis. Review of the care plan revealed on 5/4/2012 the care plan was initiated by the RN. Review of the record revealed the care plan was not updated or reviewed on 5/5/2012 and 5/6/2012.

Review of the facility policy, "Documentation: Plan of Care", last revised 9/2009, stated the plan of care will be reviewed regularly and maintained or revised based on the patient's response to treatment.

Interview with the Manager of the Unit on 5/7/2012 at 2:25 p.m. revealed the nursing standard was to review and/or revise the plan of care at least daily. The Manager confirmed the patient's plan of care was not reviewed or revised on 5/5/2012 or 5/6/2012.

4. Patient #10 was admitted to the facility's Behavioral Health Center on 5/7/2012 at 9:00 a.m. The patient's diagnosis included cellulitis of the lower leg.
Review of the physician orders dated 5/7/2012 at 4:47 p.m. stated obtain a wound culture and dressing change with Bactroban three times daily.

Observation of the patient on 5/8/2012 at 9:45 a.m. revealed the patient was sitting in the common area with the wound open to air.

Interview with the patient revealed she was awaiting a dressing change that was scheduled for 9:00 a.m.

Review of the MAR revealed the dressing change scheduled for 5/7/2012 at 5:00 p.m. was documented as "not given-does not meet criteria".

At the time of observation and interview on 5/8/2012 at 9:45 a.m. the wound culture had not collected and the dressing change had not been completed as ordered on 5/7/2012.

Interview with the RN, Chief Nursing Officer and the Nurse Manager of Behavioral Health Center on 5/8/2012 at 10:45 a.m. confirmed the above findings.

Based on record review, staff interview and review of policy and procedures it was determined the facility failed to ensure blood products were administered in accordance with the the facility's policy for one (#15) of thirty four patient's sampled. This does not ensure safe, effective and appropriate care for patients receiving blood products.

Findings include:

Review of the facility policy, "Administration of Blood and Blood Components", last revised 9/2009, stated the requisition form must remain attached to the unit of blood until the transfusion is complete and a copy will be placed in the medical record upon completion of the transfusion. The policy stated the transfusionist and a validated hospital employee are required to verify at bedside the patient's name, medical record number, date of birth, donor number, donor and recipient type, expiration date and type of component, and both employees must sign the requisition.

Patient #15 was admitted for Hydronephrosis on 5/3/2012. Review of the physician orders dated 5/4/2012 stated transfuse two units of PRBC's (Packed Red Blood Cells). Review of the record revealed the first unit was started on 5/5/2012 at 1:25 a.m. Review of the transfusion report revealed the transfusionist did not sign the requisition to confirm the correct patient and blood product. Review of the requisition revealed an RN (Registered Nurse) signed as the witness confirming the correct patient and blood product. The second unit of blood was administered at approximately 4:00 a.m. as documented in the Intake & Output. Review of the record revealed no evidence of a blood requisition for the second unit of blood.

Interview with the Manager of the Unit on 5/7/2012 at 2:25 p.m. confirmed the above findings.

Based on observation, staff interview and review of policy and procedures it was determined the facility failed to maintain code carts and fluid warmers according to facility policy. It was determined the facility failed to ensure the equipment located in the operating suite was kept free of rust. This does not ensure the facility maintains an environment that is clean, safe and in safe operating condition.

Findings include:

1. Review of Policy 200.205 last revised 12/2011 "Code Blue and Code Blue Cart Maintenance" stated in section C that the Charge Nurse or designee performs the daily Code Cart integrity check for Code Blue carts.

During tour of the Women's Hospital Operating Room Unit on 5/7/2012 at approximately 10:00 a.m. the "Code Blue Cart Checklist" was reviewed. In Operating Room (OR) Room #9 the checklist was not completed on 5/4/2012. In addition, the checklist in OR# 11 was not completed on 5/3/2012 and 5/6/2012.

Interview with the Quality Coordinator of the Women's Hospital on 5/7/12 at approximately 10:00 a.m. confirmed that the code carts are to be checked daily and the checks documented on the Code Blue Cart Checklist.

2. Review of Policy 200.729 last revised 6/2011 "Warming Blankets and Solution" Procedure B(a) stated: A warmer log will be placed on each warmer. An assigned team member will record the IV (intravenous) fluid warmers temperature with his/her initials on the log daily.

During a tour of the Women's Hospital on 5/7/2012 at 10:00 a.m. the Post Anesthesia Care Unit (PACU) Fluid/Blanket Warmer Log was not completed on 5/4/2012. A small fluid warmer in OR #11 had a blank log with no entries noted for the month of May.

Interview with the OR Manager and Quality Coordinator of the Women's Hospital on 5/7/12 at 10:30 a.m. confirmed the above findings.

3. A tour of the Women's Hospital Operating Rooms was conducted on 5/7/2012 at approximately 10:00 a.m. During the tour rusty wheel castors were observed in the following OR rooms:
· OR #11-on the biohazard waste trash bin cart, IV pole and table.
· OR # 8-on the IV pole and trash carts
· OR #6-on 2 biohazard trash bin carts. The compressed air tank was also noted to be rusty and chipped.

The above findings were confirmed at the time of the observation with the Labor and Delivery Operating Room Manager.

4. A tour of the Main Hospital main OR suite was conducted on 5/7/2012 at approximately 2:30 p.m. Heavy accumulations of rust on the wheel castors of multiple pieces of equipment were observed in OR #9, OR #10, and OR #11.

The finding was confirmed by the Director of Surgical Services on 5/7/2012 at approximately 2:30 p.m.

5. A tour of the Pharmacy was conducted on 5/7/2012 at approximately 10:45 a.m. Water was observed steadily dripping from inside the top liner of the medication refrigerator into an open plastic container placed on the top shelf beneath the dripping water. The container was approximately three-fourths full of cloudy water. It was estimated to contain approximately one gallon of water. The white liner of the refrigerator was rust-colored at the area from which the water was dripping. A white plastic bin containing medications on the shelf below the water container showed evidence of having collected water which left rust-colored debris behind when it dried.

The finding was confirmed by the Pharmacy Manager on 5/7/2012 at approximately 11:00 a.m.