HospitalInspections.org

Based on interview and record review; the Critical Access Hospital failed to maintain temperature records on the Physical Therapy hydrocollator (stainless-steel thermostatically controlled liquid heating device designed to heat packs in water up to 160 degrees Fahrenheit for warm moist packs) before use. Interview revealed that the hot packs were frequently used and the temperatures were monitored two times monthly. This had the potential to affect all the patients receiving hot packs.

Findings are:

A. Observation of the therapy gym on 5/2/18 at 8:50 AM revealed that the facility's hydrocollator was clean and stored in the gym.

B. Interview with PT (Physical Therapist) L on 5/2/18 at 8:50 AM revealed that the Therapy Receptionist was in charge of monitoring the hydrocollator's temperature.

C. Interview with Therapy Receptionist on 5/2/18 at 9 AM revealed that the Policy had changed a few months ago and now the receptionist was following the new policy and changing the hydrocollator water and taking the water temperature at the same time. When the receptionist reviewed the documentation, it was noted the temperature was not always documented. The Therapy Receptionist stated that different forms had been tried.

D. Review of the policy the Therapy Receptionist indicated Department of Rehabilitation Services Infection Control Plan section XB Revision Date: October 2017 ...stated:
- "Hydrocollator tongs and machines:
- Hydrocollator tongs will be thoroughly rinsed, scrubbed and disinfected on a weekly basis unless otherwise needed.
- Hydrocollator machines will be thoroughly rinsed scrubbed and disinfected on a monthly basis unless otherwise needed according to established cleaning procedures.
-....Allow ample time for the water temperature to return to 158- 167 degrees F (Fahrenheit... prior to using hot packs for patient care."

E. Review of the facility's Thermotherapy (application of superficial heat) policy and procedure revised April 2015 stated that Hot Packs were made of bentonite and came in various sizes to fit different areas of the body. The packs were stored in a temperature controlled hydrocollator tanks kept at 158-167 degrees F. The hot packs were wrapped in six to eight dry towel layers prior to placing on the treatment areas. The hot pack removed after 20 minutes and a skin inspection must be completed.

F. Interview with PT L on 5/2/18 at 2 PM revealed that the hot packs were frequently used on physical therapy patients.

Based on medical record review and staff interview, the CAH (Critical Access Hospital) failed to ensure the physician examined the patient immediately before surgery for 11 of 11 discharged surgical patients (Patients 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 19). This failed practice had the potential to affect all surgical patients of the CAH. Total procedures/surgeries performed from 9/9/17 to 4/27/18 was 62.

Findings are:

A. A review of Patient 1's medical record (5/2/18 at 8:15 AM) revealed the patient had a percutaneous (done through the skin) pinning of a right hand fracture on 10/4/17. The physician signed the form titled "Preoperative Evaluation" with no evidence of time to ensure the examination took place before surgery (3:31 PM) to evaluate the risk of the procedure to be performed.

-A review of Patient 2's medical record (5/2/18 at 10:00 AM) revealed the patient had a left total knee arthroplasty (total knee replacement) on 12/13/17. The physician signed the form titled "Preoperative Evaluation" with no evidence of time to ensure the examination took place before surgery (9:58 AM) to evaluate the risk of the procedure to be performed.

- A review of Patient 3's medical record (5/2/18 at 10:35 AM) revealed the patient had a repeat cesarean section (surgical procedure to deliver a baby) on 3/27/18. Review of the entire medical record revealed a lack of evidence that the physician examined the patient immediately before surgery (7:15 AM) to evaluate the risk of the procedure to be performed.

-A review of Patient 4's medical record (5/2/18 at 1:20 PM) revealed the patient had a right total knee arthroplasty on 3/21/18. The physician signed the form titled "Preoperative Evaluation" with no evidence of time to ensure the examination took place before surgery (11:52 AM) to evaluate the risk of the procedure to be performed.

-A review of Patient 5's medical record (5/2/18 at 7:55 AM) revealed the patient had a right knee arthroscopy (interior of a joint inspected and/or operated on) on 12/13/17. The physician signed the form titled "Preoperative Evaluation" with no evidence of time to ensure the examination took place before surgery (3:18 PM) to evaluate the risk of the procedure to be performed.

-A review of Patient 6's medical record (5/2/18 at 11:10 AM) revealed the patient had a laparoscopic appendectomy (specialized technique to remove the appendix that avoids the long incision used in open surgery) on 4/9/18. The physician signed the form titled "Preoperative Evaluation" with no evidence of time to ensure the examination took place before surgery (5:19 PM) to evaluate the risk of the procedure to be performed.

-A review of Patient 7's medical record (5/2/18 at 12:45 PM) revealed the patient had a right carpal tunnel release (surgery used to reduce the pressure on the median nerve in the wrist) on 12/27/17. The physician signed the form titled "Preoperative Evaluation" with no evidence of time to ensure the examination took place before surgery (2:24 PM) to evaluate the risk of the procedure to be performed.

-A review of Patient 8's medical record (5/2/18 at 11:50 AM) revealed the patient had dental restorations on 4/27/18. The physician signed the form titled "Preoperative Evaluation" with no evidence of time to ensure the examination took place before surgery (1:10 PM) to evaluate the risk of the procedure to be performed.

-A review of Patient 9's medical record (5/2/18 at 1:35 PM) revealed the patient had a partial amputation of two right fingers on 2/22/18. The physician signed the form titled "Preoperative Evaluation" with no evidence of time to ensure the examination took place before surgery (10:10 AM) to evaluate the risk of the procedure to be performed.

-A review of Patient 10's medical record (5/2/18 at 1:50 PM) revealed the patient had a left foot metatarsophalangeal joint (the joint between the metatarsal bones of the foot and the proximal bones of the toes) exploration and implant placement on 4/25/18. The physician signed the form titled "Preoperative Evaluation" with no evidence of time to ensure the examination took place before surgery (9:55 AM) to evaluate the risk of the procedure to be performed.

-A review of Patient 19's medical record (4/30/18 at 4:30 PM) revealed the patient had a laparoscopic appendectomy on 2/19/18. The physician signed the form titled "Preoperative Evaluation" with no evidence of time to ensure the examination took place before surgery (3:58 PM) to evaluate the risk of the procedure to be performed.

B. An interview with the Medical Records Supervisor (5/2/18 at 11:25 AM) revealed the facility lacked a policy and procedure for the preoperative evaluation "No policy and procedure created, only created the form".

C. An interview with the Director of Nursing (5/2/18 at 3:30 PM) confirmed the above medical records lack the evidence of the patient examinations completed by the physicians immediately before surgery to evaluate the risk of the procedure to be performed.

Based on record review and staff interview, the facility failed to ensure that swing bed patient records included a recapitulation (a concise summary) of the swing bed stay for 3 of 5 (Patients 28, 29, 31 and 32) discharged swing bed patients. This had the potential to affect all discharged swing bed patients.

Findings are:

A. A review of Patient 28's medical record lacked a recapitulation of the patient's swing bed stay from 2/26/18-2/27/18.

B. A review of Patient 29's medical record lacked a recapitulation of the patient's swing bed stay from 12/29/17-1/2/18.

C. A review of Patient 30's medical record lacked a recapitulation of the patient's swing bed stay from 2/15/18-3/5/18.

D. An interview with the Discharge Planner on 5/3/18 at 8:45 AM revealed that the Discharge Planner was unaware the recapitulation needed to be completed on the Discharge Plan for swing bed patients.