HospitalInspections.org

Based on review of facility documents, medical records (MR), and interview with staff (EMP), it was determined that the facility failed to ensure all appropriate patients, or their representatives received the Medicare Rights Appeal form for four of seven Medicare patients records reviewed (MR17, MR18, MR19, and MR21).

Findings include:

A review of facility document "Notification of Medicare Appeal Rights," dated December 2011, revealed " ... Procedure ... On admission, all appropriate patients are to receive the Medicare Rights Appeal form (IMM). This will be provided wherever the patient presents for service ... The patient must receive an explanation of their rights, then sign and date the first page of the triplicate form. ... If a patient is unable to comprehend the explanation or unable to sign the form, the Emergency Department Registration Staff must call the nearest family member/representative, Power of Attorney or Nursing Home Administrator with an explanation of the Patient's Rights and document the communication on the form. Every attempt must be made to notify the nearest relative or responsible party if the patient is unable to sign, including faxing the form for signature or sending a certified letter, if required ... In addition, the Case Managers/Social Workers must re-issue the notice two (2) days prior to discharge ... "

A review of MR17, MR18, MR19, and MR21, revealed no documented evidence that the facility informed the patient, or when appropriate, the patient's representative of the patient's rights concerning the IMM, in advance of furnishing or discontinuing patient care.

An interview conducted on January 9, 2013, at 9:40 AM, with EMP2 confirmed that MR17, MR18, MR19, and MR21, revealed no documented evidence that the facility informed the patient, or when appropriate, the patient's representative of the patient's rights concerning the IMM, in advance of furnishing or discontinuing patient care.

Based on review of facility documents, medical records (MR), and interview with staff (EMP), it was determined that the facility failed to follow hospital policy regarding notification of the patient's family on the placement of restraints for three of three medical records reviewed (MR21, MR22, and MR23).

Findings include:

A review of facility policy, "Restraint and Seclusion," dated November 2012, revealed, " ... The use of Restraints: ... Acute M/S [Medical / Surgical] (non-violent or non-destructive) ... Documentation ... The 24 hours MS Restraint flow sheet is used for the documentation when a patient is acute M/S restraint ... Documentation also indicates date and timing of application ... type of restraint ... Family notification and instruction ... "

A review of MR21, MR22, and MR23, revealed the patient's listed in each medical record were placed in Medical / Surgical restraints. Further review of MR21, MR22, and MR23, revealed no documented evidence that each patients' family was notified that restraints had been applied.

An interview conducted on January 9, 2013, at 10:00 AM, with EMP2 confirmed that hospital policy required family notification for the application of restraints and that MR21, MR22, and MR23, revealed no documented evidence that each patients' family was notified that restraints had been applied.

Based on review of facility documents, medical records (MR), and interview with staff (EMP) it was determined that the facility failed to ensure that approved symbols and abbreviations were used for four of four medical records reviewed (MR14, MR24, MR25, and MR26).

Findings include:

A review of facility document "Medical Record Abbreviations & Symbols," dated December 2011, revealed " ... Responsibility: All persons documenting in the patient medical record are responsible for using only approved abbreviations ... Do Not Use ... < ... > ... @ ... cc ... + ... = ... [arrow pointed up symbol] ... [triangle symbol] ... "

A review of medical records revealed the documented use of unapproved abbreviations on physician orders and medication administration records:

MR14 - "cc" and ">" dated November 25, 2012; "@" and "cc" dated November 26, 2012; triangle symbol dated November 28, 2012.

MR24 - ">" dated October 27, 2012; "<" dated October 28, 2012; "@" dated October 29, 2012; arrow pointing down symbol, "=" , ">" , and "<" dated October 31, 2012; " < " and " > " dated November 1, 2012.

MR25 - " @ " , " cc " , and " < " , dated August 21, 2012; " @ " dated August 26, 2012; and " > " dated August 27, 2012.

MR26 - " > " , " < " , " = " , " cc " , " @ " and triangle symbol dated August 31,2012; " + " dated September 1, 2012; arrow pointed up symbol dated September 3, 2012; triangle symbol dated September 4, 2012

An interview conducted on January 9, 2012, at 2:30 PM with EMP1 confirmed that the abbreviations listed above were used in these medical records and were not in accordance with the facility's policy for approved abbreviations.

This condition level deficiency was cited during a Division of Life Safety survey completed on January 17, 2013. Further details are provided in the Division of Life Safety report.

Based on review of facility policy, manufacture's instructions, observations and interview with staff (EMP), it was determined that the facility failed to ensure that supplies were maintained to ensure an acceptable level of safety.

Findings include:

Review of facility document "LBH Safety / Environment Rounds Ancillary Non-Inpatient Clinical Areas," dated March 2005, revealed," ... Clean storage area is clean ... No expired items ... "

1) Observation on January 8, 2013, of the Radiology Department's Computed Tomography (CT) room revealed the following expired products: five Quick Core disposable biopsy needles marked expired November 2011, seven Quick Core disposable biopsy needles marked expired January 2012, one spinal needle marked expired January 2012, and one BD Vacutainer marked expired June 2012.

An interview on January 8, 2013, at 9:50 AM, with EMP3 confirmed the above mentioned products were expired.

2) Observation on January 8, 2013, of the Radiology Department's Ultrasound Room number three revealed four 160-R skin markers with rulers marked expired September 2012.

An interview on January 8, 2013, at 10:00 AM, with EMP3 confirmed the above mentioned products were expired.

3) Observation on January 8, 2013, of the Radiology Department's Interventional radiology room revealed a box of HiWire Hydrophilic Wire Guides marked expired December 2012.

An interview on January 8, 2013, at 10:15 AM, with EMP3 confirmed the above mentioned product was expired.

4) Observation on January 8, 2013, of the Radiology Department's MRI Room revealed six 0.9% Sodium Chloride Injection, USP marked expired August 2012 and one Vanish Point Tuberculin syringe marked expired October 2011.

An interview on January 8, 2013, at 10:30 AM, with EMP3 confirmed the above mentioned products were expired.

5) Observation on January 8, 2013, of the Radiology Department's MRI Control Room revealed 77 0.9% Sodium Chloride Injection, USP marked expired August 2012 and one Protect IV Safety I.V. Catheter marked expired January 2012.

An interview on January 8, 2013, at 10:35 AM, with EMP3 confirmed the above mentioned products were expired.

6) Observation on January 8, 2013, of the Radiology Department's MRI Holding Area revealed eight MRI ECG electrode packages marked expired October 23, 2012, and 11 MRI ECG electrode packages marked expired November 13, 2012.

An interview on January 8, 2013, at 10:45 AM, with EMP3 confirmed the above mentioned products were expired.

Review of facility policy " #1C-Respiratory Therapy ...D. Pulmonary Function Equipment ... 1. Change mouthpieces and filters between patients. 2. Sterilize or subject to high level disinfection reusable mouthpieces and connectors between uses on different patients. High level disinfection can be achieved by wet pasteurization at 76 degrees Celsius for 30 minutes. 3. Dispose of the filter. 4. Change tubing weekly. ..."

Observation on January 8, 2013, at 10:10 AM revealed discolored tubing on the PFT machine in the Pulmonary Function Outpatient testing office.

Interview on January 8, 2013, at 10:10 AM, with EMP5 confirmed that respiratory staff had not changed tubing or filters in accordance with facility policy. There was no documented evidence that tubing and filters were cleaned and changed in accordance with facility policy.

Review of manufacturer 's instructions for a pneumatic pasteurization machine (a machine utilized for high level disinfection of reusable mouthpieces for pulmonary function machines and for reusable water traps used on facility respirator circuits), dated 2012, revealed "Cleaning procedure ... The tank should be cleaned at least once a week, or more often if local water conditions result in severe scale buildup ..."

Observation on January 8, 2013, at 10:00 AM of the respiratory decontamination and cleaning room revealed a pneumatic pasteurization machine left in the open position. The water contained inside the machine was cloudy with noted scaling on the basket that holds the instruments. The machine was also noted with out printer paper that is utilized to log temperatures during disinfection of instruments.

Interview on January 9, 2013, at 9:50 AM, with EMP5 confirmed that the pasteurmatic was not cleaned at least once a week in accordance with manufacture's instructions. EMP5 confirmed that the machine was used without printer paper. The printer paper captures the digital read outs to ensure proper disinfection of instruments during each load. There was no documented evidence that the facility was adequately monitoring and maintaining this machine.

Based on review of facility documents, medical records (MR), and interview with staff (EMP), it was determined that the facility failed to provide Medicare beneficiaries with a list of Home Health Agencies (HHAs) or Skilled Nursing Facilities (SNFs) for two of seven medical records reviewed (MR14 and MR30).

Findings include:

A review of facility document "Acknowledgement of Freedom," undated, revealed " ... Acknowledgement of freedom to choose a Home Health Care/Hospice or DME Provider. Your Physician has prescribed home health services to assist your transition form hospital to home. Inclusion on this loist [sic] does not mean that Lower Bucks Hospital recommends the agency. ... "

A review of MR14 and MR30 revealed that these patients were Medicare patients who were discharged with HHA services. There was no documented evidence in these medical records that these patients were provided a HHA list.

Interview on January 9, 2013, at 9:30 AM, with EMP2 confirmed that there was no documented evidence in MR14 and MR30 that these Medicare patients received a HHA list.