HospitalInspections.org

Based on observations, policy/procedure review, document review and staff interviews, the Critical Access Hospital (CAH) staff failed to document the use date on 2 of 2 bottles of glucometer control solutions opened for 2 of 2 glucometers utilized in accordance with the manufacturer's instructions. (Nursing) The CAH staff identified a census of 5 patients at the start of the survey.

Nursing administration reported 131 glucose tests performed on the nursing unit since January 2016.

Failure to document the date staff opened the bottles of glucometer control test solutions could potentially allow staff to use the solution after the manufacturer's expiration date, potentially resulting in inaccurate test results, which could lead to patients receiving inappropriate treatment.

Findings include:

1. Observation on 8/15/16 at 2:45 p.m., during the tour of the nursing unit Staff A, RN, (Registered Nurse) DON (Director of Nursing) , revealed 2 glucometers located in the nursing unit. One glucometer contained 2 opened and undated glucometer control test solutions.

2. Review of the CAH policy/procedure titled, Blood Glucose Monitor Control Testing (Accu-check Advantage), revised 7/11, lacks information regarding the dating of control vials when opened.

3. Review of the manufacturer's instructions found on the package insert reads in part...Write the date you open the bottle on the bottle label. The control solution must be discarded 3 months from that date or on the Use By date printed on the bottle label, whichever comes first.

4. An interview on 8/15/16 at 2:45 p.m., during the tour of the nursing department, Staff A, acknowledged the open control bottles for the glucometers lacked an opened by date.

Based on document review, policy review and staff interview the CAH administrative staff failed to establish a system to identify and prevent transmission of infections and communicable diseases for contracted staff, whom regularly provide CAH services. The problem was identified for 2 of 3 contracted staff selected for review. Administrative staff reported a census of 5 patients.

Failure to identify infections and communicable diseases among contracted staff could potentially result in the transmission of a communicable disease to patients.

Findings include:

Review of an Employee Health policy titled "Contract Employees Reporting Process" revised 8/17/09, revealed the policy required proof of a current Tuberculosis skin test and information regarding infections and communicable diseases, but the policy lacked a requirement for a health assessment/physical.

Review of policy titled "General Information to the New Employee", revised 1/21/13, revealed a requirement for a physical upon hire and every 4 years thereafter.

Review of the personnel files for Staff B, Contracted Speech Therapist and Staff C, Contracted Occupational Therapist, revealed the files lacked documented evidence of a health assessment/physical.

During an interview on 8/18/16, at 9:20 a.m., Staff E, Employee Health reported the CAH failed to require proof of a physical/health assessment for contract employees, thus the facility was unable to provide any documented evidence for Staff B or Staff C. Staff E confirmed the identified contracted staff regularly provided services at the CAH.

Based on review of closed colonoscopy medical records, CAH (Critical Access Hospital) policy and procedures, and staff interview the CAH staff failed to document the responsible adult that accompanied the patient at discharge for 5 of 5 (Patients #25, #26, #27, #28 & #29) colonoscopy patients.The CAH staff identified a census of 5 patients at the start of the survey.

Nursing administration reported 31 colonoscopies performed since January 2016.

Colonoscopy patients are given IV (intravenous) conscious sedition for the procedure, failure to document the responsible adult at the time of discharge for the colonoscopy patient, could result in patient operating a motorized vehicle or machine while under the influence of sedition.

Findings include:

1. Review of patient records revealed the following:
a. Patient # 25, admitted on 7/15/2016 for colonoscopy received IV conscious sedation, was discharged on 7/15/16. Discharge documentation failed to identify a responsible adult that accompanied Patient #25 upon discharge.
b. Patient # 26, admitted on 7/15/2016 for colonoscopy received IV conscious sedation, was discharged on 7/15/16. Discharge documentation failed to identify a responsible adult that accompanied Patient #26 upon discharge.
c. Patient # 27, admitted on 6/10/2016 for colonoscopy received IV conscious sedation, was discharged on 6/10/16. Discharge documentation failed to identify a responsible adult that accompanied Patient #27 upon discharge.
d. Patient # 28, admitted on 7/15/2016 for colonoscopy received IV conscious sedation, was discharged on 7/15/16. Discharge documentation failed to identify a responsible adult that accompanied Patient #28 upon discharge.
e. Patient # 29 admitted on 6/10/2016 for colonoscopy received IV conscious sedation, was discharged on 6/10/16. Discharge documentation failed to identify a responsible adult that accompanied Patient #29 upon discharge.

2. Review of policy titled, Medication-IV Conscious Sedation, revision date 7/12, reads in part... Post-Procedure 2. Patient may be discharged from the procedure area when the following discharge criteria have been met...A responsible adult accompanies the patient. 3. Reinforce discharge instructions to the patient and family that are specific to conscious sedation these are to include at a minimum...No driving or operating motorized equipment for 24 hours.

3. An interview on 8/18/16 at 7:45 a.m. with Staff A, RN (Registered Nurse) DON (Director of Nursing), acknowledged the medical records for Patients #25, #26, #27, #28 & #29, failed to contain documentation of discharge and the responsible adult that accompanied the patient.