HospitalInspections.org

The Critical Access Hospital (CAH) reported a census of 11 patients. Based on observation, staff interview and policy review the CAH failed to keep all equipment for treating emergency pediatric cases readily available. One of One Braslow bag (bag containing pediatric emergency supplies) contained outdated supplies.
Findings included;
- Observation of the CAH emergency department on 1/27/14 at 11:05am revealed the following outdated supplies in the Braslow bag;
1. Three 24 gauge IV catheters (used for intravenous access) with an expiration date of 11/2011.
2. Three 20 gauge IV catheters with an expiration date of 11/2011.
3. Five 18 gauge IV catheters with an expiration date of 7/2011.
4. Seven IV start kits (containing dressings for IV insertion site) with an expiration date of 4/2011.
5. One 15 gauge adjustable length sternal/iliac aspiration needle (needle used to gain access to bone marrow with an expiration date of 3/2011.
6. 10 small bore extension kits for intraosseous (in the bone) needles with an expiration date of 3/2011.
- Policy entitled Outdated Product, dated 5/22/02 observed on 1/30/14 at 2:32pm states " All departments will check for outdates and take outdates to materials for replacement. "
- Administrative staff A interviewed on 1/27/14 at 11:30am verified outdated equipment.

The Critical Access Hospital (CAH) reported 11 patients. Based on observation, staff interview and document review, the CAH failed to develop and implement a system to identify the potential risk of infection during endoscopy procedures (the use of a flexible tube to visualize the gastrointestinal tract). The re-use of a single-patient use only solution for multiple patients has the potential to place any subsequent patients at risk for cross-contamination and infection.

Findings include:

- Bottles of sterile water are stored in a cupboard in the endoscopy suite. The sterile water bottle is to be attached to the endoscope system for procedures. The label on the sterile water bottle revealed the bottle is intended for "single use only". The sterile water is used to irrigate the patient's gastrointestinal tract during the procedure.

- Administrative Registered Nurses A and B, interviewed on 1/28/14, acknowledged the package directs 'single use only' and confirmed the sterile water is new for each day's procedures. Staff A and B confirmed that, if more than one endoscopy procedures are done the same day, the staff do not change the sterile water and continue to use the bottle of sterile water for the additional procedures.

- The Critical Access Hospital lacked evidence the sterile water is appropriate for re-use on subsequent patients and procedures.

The Critical Access Hospital (CAH) reported eleven patients. Based on medical record review, document review and staff interview, the CAH failed to ensure each entry in the patient's medical record is signed, dated and timed for four of eleven acute and swing bed care patients with records reviewed (patient #'s 11, 15, 17 and 18).

Findings include:

- The Critical Access Hospital policy titled "Health Information management", reference #1004A directs "All entries in the medical record are to be dated timed and authenticated".

- Patient #11's medical record, reviewed on 1/27/14, revealed an admission date of 9/17/13. The clinical record lacked the providers' signature, date and/or time on entries made on 1/27/14, 1/20/14, 1/17/14, and at least 27 other entries in the medical record by a provider.

- Patient #15's medical record, reviewed on 1/27/14, revealed an admission date of 1/26/14. Patient #15's medical record lacked the providers' signature, date and/or time on the admission orders and progress notes.

- Patient #16's medical record, reviewed on 1/28/14, revealed an admission date of 9/17/13. The medical record lacked the providers' signature, date and/or time on entries in the record by the medical student and/or the physician assistant.

- Patient #18's medical record, reviewed on 1/28/14, revealed an admission date of 12/17/13. The medical record lacked the providers' signature, date and/or time on admission orders, and other entries on 12/17/13, 12/20/13, 12/23/13, 12/26/13, 12/30/13 and 1/10/14.

- Medical records staff D, interviewed on 1/28/14 at 8:30am, acknowledged the Critical Access Hospital failed to monitor the medical records for completeness including signed, dated and timed entries.