HospitalInspections.org

Based on observations, document review and interview. The facility did not ensure
(a) Eye drop medications were secured and not accessible to patients or visitors in patient care areas and (b) expired eye medications were not available for patient use.

These lapses in environmental and medication safety, place patients at increased safety risks.

Findings pertinent to A:

During observations in the facility's Level 3 section of the Emergency Department (area where COVID positive patients were treated) on 6/23/20 at 1:30PM, two (2) bottles of Phenylephrine and one (1) bottle of Alcon eye drops, were observed on a cabinet, unattended, in exam room B1-28B, with the door open, near the patient restrooms.

This was observed in the presence of Staff Q (Director of the Emergency Department), Staff H (Associate Director of Emergency Department) and Staff M (Associate Executive Director of Emergency Nursing Services), who confirmed that the eye medications should have been secured.

The facility policy and procedure (P&P) titled "Medication Storage" last reviewed 7/2019, contained the following statements: "Procedure: Medication storage in nursing units ...medications are stored in locked medication rooms, locked medication carts and automated dispensing cabinets...certain low risk medications may be store in locked clean utility rooms.

Findings pertinent to B:

Observations in the facility's Level 3 section of the Emergency Department (area where COVID positive patients were treated) on 6/23/20 at 1:30PM, identified the following:

Two bottles of Phenylephrine (Eye drop Medications) were observed on a cabinet, in exam room B1-28B. One (1) bottle of the medication had an expiration date of 3/9/20, and the other did not have a visible expiration date.

This was observed in the presence of Staff Q (Director of the Emergency Department), Staff H (Associate Director of Emergency Department) and Staff M (Associate Executive Director of Emergency Nursing Services), who confirmed that the eye medications should not have been available for patient use.

The facility policy and procedure (P&P) titled "Medication Storage" last reviewed 7/2019, contained the following statements: Expired / damaged/ contaminated medications are removed from patient care areas according to established guidelines."

Based on the observation, staff interview and document review, the facility failed to provide a functional and sanitary environment for the provision of emergency care for the patients. Specifically, the ED (Emergency Department) design did not provide the necessary space to safely care for medically unstable or critically ill patients who require immediate interventions.

The failure to maintain clear space and clearance between the beds can affect the timely care for the patients, their safety and may contribute to breeches in infection control.

Findings include:

In accordance with nationally recognized standards any nursing unit room with multiple bed "shall be a minimum of eighty square feet of bed" and " patient beds shall not be spaced closer than three feet from each other and sides of the bed shall be at least two feet away from walls".

The facility's current floor plan of the ED revealed that each bay in the Level 2 area was 76.125 square feet.

During the tour of (Observations in ) the facility's ED (Emergency department) on 06/23/2020 at 1:09 pm in Level 2 area (where non-COVID patients are treated), it was observed that two patients were cohorted in bay A1, A2 and A8.

During this tour it was also observed that a) the patient care bed 1 in bay A1 was next to the wall,
b) clearance between patient beds were only 2 feet in bay A1, A2 and A8, c) Patient bed 2 in A1 and patient bed 1 in A2 were only separated by (a) privacy curtain.

During the interview of Staff H (Associate director of ED) at the time of observation, he stated that two patients are cohorted in the same bay due to the surge of patients and often done to give faster treatment for the patients.

The above finding was brought to the attention of facility's administration during the end of day conference on 06/24/2020.

Based on observation, document review and interview, the facility did not ensure that staff donned face masks appropriately to prevent the spread of COVID-19 as required by hopsital protocol.

Failure to adhere to infection control standards may place patients and staff at increased risk for COVID-19 infection.

Findings included:

Observation in the facilities main lobby identified the following:
On 6/23/2020 at approximately 9:30 AM, two staff members, wearing clothing with the Elmhurst Hospital logo, were observed in the hospitals main lobby walking past the facility security guard and information desk. One staff member had his face mask pulled under his chin and one was without a face mask

On 6/32/2020 at 11:30 AM a housekeeping staff member was observed cleaning the hospital main lobby area without mask on. Per interview with the housekeeping staff member at the time of the observation he stated, "he knows he is to wear the face mask".

This finding was confirmed by staff O (Associate Director Quality Management) who was present during the tour.

During an interview with staff F (Attending Physician Medicine/Epidemiologist), she stated, "that all staff received training on the use of PPE (Personal Protective Equiptment)".

Training poster at Elmurst Hospital stated, UNLESS OTHERWISE POSTED, ALL AREAS OF NYC HEALTH + HOSPITALS/ELMURST ARE LEVEL 1 ZONE You must wear surgical mask; you must practice continuous hand washing after touching doors and equipment.

An email dated May 14, 2020, Subject: Elmhurst Recommendation for the use of PPE during the COVID-19 pandemic, stated, "All non-patient care areas including break room, conference rooms, staff elevators, and shared office spaces have been deemed Level 1 zones". "A mask should be worn at all times in Level 1 zones.

Based on observation, and interview, the facility failed to ensure that staff followed standard Infection Control Practices regarding the storage of supplies.

The failure to dispose the used/ unsterile supplies may contribute to breeches in infection control and places all patients at risk for potential infection.

Findings include:

According to CDC guidelines, all disposable medical supplies should be disposed, and all non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer's instructions and facility policies.

Observations in the facility's ED (Emergency department) on 06/23/2020 at 1:27 pm in Level 3 area (where suspected COVID patients are treated) exam room ( B1-28B), identified the following: the room contained three cardboard boxes and 1 plastic box with opened Bi pap ventilator breathing circuits, cloths, miscellaneous supplies and expired eyedrops. The door of this is room was open at the time of observation.

Staff H (Associate director of ED) was present at the time of observation and upon interview she stated that the supplies are unsterile.

On interview of Staff P (Associate executive director) on 6/24/2020 at 11:25 am, he stated that used breathing circuits are disposed with medical waste (red bag).

The above finding was brought to the attention of facility's administration during the end of day conference on 06/24/2020.