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Based on interview and record review, the facility failed to inform each patient of their patient rights.

Failure to do so risks patients not being aware of their rights, and therefore unable to exercise them.

Findings:

On 12/12/12 Surveyor #1 asked Staff #1 what the hospital ' s process was for informing patients of their rights. Staff #1 stated that the list of rights was given to patients by registration staff in a packet when the patient was admitted. Surveyor #1, along with Staff #1, interviewed a registration staff member, who stated that these packets were only given to persons who were admitted as inpatients. Persons who received services as an outpatient did not receive this packet. Together with registration staff Surveyor #1 and Staff #1 reviewed the documents which were given to outpatients; the list of patient rights was not included.


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Based on observation, facility staff failed to store and prepare medications according to facility security policy and accepted standards of practice.

Failure to do so places patients at risk for receipt of drugs which may have been tampered with, or experiencing medication errors.

REFERENCES:
WAC 246-873-070 Physical requirements. The pharmacy facilities shall include: (4) Drug storage areas. Drugs shall be stored under proper conditions of sanitation, temperature, light, moisture, ventilation, segregation, and security.

WAC 246-873-080 Drug procurement, distribution and control.
(5) Labeling: (a) Inpatient. All drug containers in the hospital shall be labeled clearly, legibly and adequately to show the drug's name (generic and/or trade) and strength when applicable.

Findings:

During tour of the Medical-Surgical Unit on 12/11/12 Surveyor #1 pulled on the door of the refrigerator attached to the automatic drug dispensing cabinet, and found it unlocked. Staff #2 contacted Staff #3, a pharmacy staff member, who arrived to examine the cabinet. Staff #3 verified that the lock was not functional on the refrigerator, and stated that facility policy required it to be locked. This cabinet was repaired during the course of the survey.

During tour of the peri-operative (OR) area on 12/13/12 Surveyor #1 examined the cart containing pediatric supplies, which was unattended. The top drawer, containing a large variety of drugs, was unlocked. Staff #10 stated that the cart was to be locked when not in use.

During tour of the OR on 12/13/12 Surveyor #1 observed unlabeled medication syringes atop an anesthesia cart during two separate surgeries. The syringes had both been filled by Staff #4. They were not used immediately but put aside, thus risking medication errors, and not conforming to a professional standard of practice.


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Based on observation and interview, facility staff failed to implement elements of the requirements of the State Food Service Regulations, as defined in "Washington State Retail Food Code Working Document, Chapter 246-215 WAC, a modification of the 2001 FDA Food Code".

Failure to comply with the State Food Service Code puts patients, staff and visitors at risk for food borne illness.

Findings:

1. On 12/12/12, at 9:30 am, during a tour of the dietary services department, Surveyor #2 observed the following items available for use in a walk-in cooler, past their "use by" date:
a. 3 containers of bread crumbs (expiration date: 3/2012)

b. 1 container of sour cream (expiration date: 11/28/2012)

This finding was confirmed by Staff #11, who is the Food Service Coordinator. The expired items were discarded at the time of the survey.

Ref: Washington State Retail Food Code Working Document Chapter 246-215 Washington Administrative Code (WAC), Modification of 2001 FDA Food Code, Chapter 3-101.11.

2. On 12/12/12 at 9:15 am, during a tour of the dietary services department, Surveyor #2 observed Staff #12 discard egg "debris" from a spatula by "banging it" against the edge of the adjacent trash container. She/he then proceeded to continue using the spatula with the frying pan on the grill containing more eggs.

Ref: Washington State Retail Food Code Working Document Chapter 246-215 Washington Administrative Code (WAC), Modification of 2001 FDA Food Code, Chapter 3-304.12 (C).




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Based on observation, the facility staff failed to assure a proper air balance between a soiled utility room and the adjacent corridor.

Failure to provide ventilation that establishes proper air pressure relationships puts patients, staff and visitors in the hospital at risk from possible exposure to chemical and biological contaminants.

Findings:

1. During a tour of the "Medical/Surgical" unit on 12/11/12 at 1:50 pm, Surveyor #2 used a lightweight string to assess the direction of air flow between a soiled utility room near the nurse's station and the corridor. The air flow was neutral to the corridor rather than negative (pulling in) as required by state regulation.



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Based on observation, interview, and record review the facility failed to develop and/or implement and maintain policies and procedures for specific infection prevention practices.

Failure to do so places patients and staff at risk for infections, resulting in debility, pain, suffering, extended hospital stays, increased health-care costs, and death.

Findings:

Part I
1. During tour of the Emergency Department (ED) on 12/12/12 Surveyor #1 observed two " tote " baskets approximately 12 " wide by 24 " long. These were filled with patient care supplies used for drawing blood and starting intravenous (IV) lines, and were stored directly adjacent to handwashing sinks at the nursing station. Staff #5 confirmed that these totes were routinely taken into the patient rooms for performing patient care, then removed and stored again at the nursing station. S/he acknowledged that this subjected all items in the totes to contamination, and that cleaning such items was not possible.

2. During tour of the Imaging Department on 12/12/12 Surveyor #1 observed a similarly equipped tote basket in the CT room. Staff #6 stated that the tote remained in the room at all times, which was a direct patient care area, and therefore subjected the patient care items to contamination.


PART II Perioperative Area (OR)

Reference:
Facility policy titled "Hand Hygiene", dated 02/12 read in part that hand hygiene was to be performed:
1. After contact with body fluids or excretions, mucous membranes ...
2. If moving from a contaminated body site to a clean body site during patient care
3. After removing gloves

On 12/13/12 Surveyor #1 observed activities in the OR during performance of two surgical cases, and observed breaches of hand hygiene (HH):
1. Staff #7 suctioned a patient, removed gloves, but did not perform HH
2. Staff #8 performed patient care, removed gloves, but did not do HH
3. Staff #4 put a breathing tube in the patient ' s throat, used the same pair of gloves to apply ointment to the patient ' s eyes, then still without changing gloves and doing HH administered sterile medication to the patient via an IV line

While observing other OR activities for these two patients Surveyor #1 found other breaches of infection control practice:
1. While observing both patient procedures Staff #4 failed to securely tie his/her surgical mask to the face, resulting in the mouth not being completely covered, and was heard to cough during the procedures. Facility policy " Surgical Services Structure Standards " dated 02/12 read in part " Masks are disposable and cover the nose and mouth ... " whenever sterile supplies are open. "
2. Staff #4 dropped an oral suction tip onto the floor, picked it up and tucked it under the patient ' s pillow to be re-used; another staff member intervened and provided a replacement.
3. Both Staff #4 and #7 injected sterile medications into the patients ' IV lines without first cleaning the injection ports.
4. Staff #4 removed a pair of (unwrapped) scissors from a cart drawer and used them to pry off the top of a vial of sterile medication, in order to pour the drug into a container on the sterile field.

While completing the tour of the OR Surveyor #1 observed that the laryngoscope blades (used to assist insertion of patient breathing tubes) were stored unwrapped in the anesthesia carts. Staff #10 stated that the blades underwent high level disinfection after use, and agreed that they should be wrapped to protect from contamination while awaiting use for another patient. The anesthesia carts were also equipped with oral suction tips which had been readied for use by removing them from their packages, thus exposing them to contamination.


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PART III Wound Clinic

Findings:

1. On 12/11/12 at 2:25 pm, during a tour of the Wound Clinic, Surveyor #2 observed a member of the clinic staff remove his/her PPE and hang it outside the patient door, rather than discard it before leaving the patient room as required in the facility policy.

2. On 12/11/12 at 2:35 pm, during a tour of the Wound Clinic, Surveyor #2 observed a member of the clinic staff exit a patient room, go to a work station and use the keyboard, without first using alcohol-based hand rub when exiting the patient room.



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Based on interview the facility failed to have effective procedures in place to address a specific emergency situation.

Failure to do so risks patient care by staff unprepared to competently perform vital tasks, potentially resulting in patient debility and death.

Findings:

During tour of the Medical-Surgical unit on 12/11/12, which cares for patients who have received drugs known to trigger a Malignant Hyperthermia (MH) crisis, Staff #2 stated that no process had been considered to respond to MH in this area. This was confirmed by Staff #9 on 12/12/12, who stated the MH plan in place focused on the perioperative area. On 12/12/12 in the Staff #5 stated that the triggering agent, succinylcholine was used in the Emergency Department but that similarly, no process had been developed to respond to MH in this area.