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Based on observations, records reviewed and interviews the Hospital failed to consistently provide for patient safety related to emergency suction equipment and the safe handling of medications.

1.) The Surveyor toured the Behavioral Health Services Unit (Saint Dymphna) and interviewed the Nurse Manager and the Assistant Nurse Manager at 11:30 A.M. on 5/8/17.

The emergency equipment was housed in a secured room on the Behavioral Health Unit and consisted of the code care and a portable suction machine.

The Nurse Manager said that the Unit was responsible to provide the emergency equipment to the medical responders if there was a medical emergency that occurred on the Unit.

The portable suction unit was disassembled and would require several pieces of additional equipment to be made functional. The canister and the suction catheters were located in the code cart; however, the extension tubing could not be located during the twenty minute tour. The emergency suction equipment would not have been available for use in an emergency.

2.) The Surveyor toured the Merrimack Valley Campus Operating Room (OR) and interviewed the Operations Manager of Surgical Services and Educator for the Operating Room at 10:00 A.M. on 5/10/17.

The Surveyor was told that there were no booked cases in the Operating Room for the day. The Surveyor observed a syringe left on the anesthesia cart of OR #2. The syringe was labeled as "fentanyl" (a powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent. It is a schedule II prescription drug.) holding approximately 1 cc of clear fluid. There were no Hospital staff in the room with the syringe.

The Operations Manager of Surgical Services said the syringe should not have been there and she left the room returning with Physician #2, the on duty Anesthesiologist.

Physician #2 said following the Hospital's policy for any unused portion of fentanyl that it was to be wasted in the presence of a witness. Physician #2 said a syringe of fentanyl was to be kept with the practitioner until it could be wasted.

The Hospital failed to follow policy when a post-anesthesia assessment by the Anesthesia Department was not documented on two of three post procedure patients (Patient #7 and Patient #8) requiring a post anesthesia assessment.

Patient #7 was post operative from a gall bladder removal. There was no post-procedure note from Anesthesia to review vital signs, respiratory status, level of consciousness and level of pain post procedure as required.

Patient #8 was postoperative from an open hernia repair with mesh. There was no post-procedure note from Anesthesia to review vital signs, respiratory status, level of consciousness and level of pain post procedure as required.

Risk Manager #2 was unable to locate any additional documentation.