HospitalInspections.org

Based on observation, review of facility policy, and interview, the facility failed to maintain the daily Emergency Cart Check List for one of three emergency carts observed.

The findings included:

Observation on September 2, 2014, at 8:45 a.m., in the Physical Therapy (PT) Department, revealed an emergency cart located in the Cardiac Rehabilitation room. Further observation revealed the daily emergency cart was last checked on May 23, 2014.

Review of the facility's policy Crash Cart Check and Emergency Drugs, last reviewed on January 12, 2012, revealed "...the crash cart is checked a minimum of every 24 hours; except when the department is closed such as the weekend...when the department is closed a notation on the checklist should indicate this..." Further review revealed "...date, shift, signature and initials are to be used to verify items present and the defibrillator is working properly..."

Interview with the PT director on September 2, 2014, at 8:55 a.m., in the Cardiac Rehabilitation room, confirmed the emergency cart had not been checked since May 23, 2014, and the facility failed to follow the facility's policy.

Based on observation, interview, and review of facility policy, the facility failed to ensure expired laboratory supplies were not available for use in one of three cabinets and expired medications were not available for patient use in one of one medication refrigerators.

The findings included:

Observation on September 2, 2014, at 9:15 a.m., in the Laboratory, revealed one 500 milliliter (ml) bottle labeled Three Step Stain (stain used for blood smears and urine drug screens). Further observation revealed the expiration date on the bottle was October 10, 2013.

Interview with the Laboratory Technician on September 2, 2014, at 9:30 a.m., in the Laboratory, confirmed the 500ml bottle of Three Step Stain was expired and available for use.


31022


Observation on September 2, 2014, at 2:45 p.m., with the Emergency Department (ED) Manager, in the medication storage room, revealed an open previously used ten milliliter (ml) vial of Novolog (insulin). Continued observation revealed the Novolog had an expiration date of June 15, 2014.

Review of facility policy, Disposal of Medications, last reviewed on July 21, 2014, revealed "...all expired medications...shall be disposed of..."

Interview on September 2, 2014, at 2:48 p.m., with the ED Manager, in the medication storage room, confirmed the Novolog was expired and available for patient use. Continued interview confirmed the facility did not follow facility policy.

31022

Based on observation and interview, the facility failed to follow infection control guidelines in two of two inpatient rooms and one of four Emergency Department (ED) rooms.

The findings included:

Observation on September 2, 2014, at 2:03 p.m., with the Assistant Administrator and Licensed Practical Nurse (LPN) #1, in inpatient room #27, revealed the room was vacant and ready for the next admitted patient. Continued observation revealed a pneumatic compression pump and stockings (device used to decrease incidence of blood clots) were stored on a shelf in the clothes closet. Further observation revealed an open package containing three disposable underpads (waterproof pads used for incontinent patients) stored in the clothes closet.

Interview with LPN #1, on September 2, 2014, at 2:03 p.m., in room #27, revealed "...I am not sure if they are clean...my guess is they had a patient in here they were used for and they put them up there..."

Interview with the Assistant Administrator, on September 2, 2014, at 2:03 p.m., in room #27, confirmed the room was clean and ready for the next admitted patient and the items "...shouldn't be there..."

Observation on September 2, 2014, at 2:08 p.m., with the Assistant Administrator and LPN #1, in inpatient room #10, revealed the room was vacant and ready for the next admitted patient. Continued observation revealed a pulse oximetry probe (used to measure oxygen levels) and two blood pressure cuffs were stored on a shelf in the clothes closet.

Interview with LPN #1, on September 2, 2014, at 2:08 p.m., in room #10, revealed "...again I am not sure if they are clean..."

Interview with the Assistant Administrator, on September 2, 2014, at 2:08 p.m., in room #10, confirmed the room was clean and ready for the next admitted patient and the items "...shouldn't be there..." Further interview confirmed the facility failed to follow infection control guidelines in the two inpatient rooms.

Observation on September 2, 2014, at 2:35 p.m., with the Assistant Administrator, in ED room #4, revealed the room was empty, clean, and ready for the next ED patient. Continued observation revealed the stretcher mattress had numerous cracks and the foam was exposed. Further observation revealed a red substance on the rails on the left side of the stretcher.

Interview with the Assistant Administrator, on September 2, 2014, at 2:35 p.m., in ED room #4, confirmed the mattress was cracked, the foam was exposed, and a red substance was on the stretcher rails. Continued interview revealed "...not sure what it is...would be afraid to say..." Further interview confirmed the facility failed to follow infection control guidelines.

Based on medical record review and interview, the facility failed to reassess a patient's condition for two (#15 and #17) of twenty patients reviewed.

The findings included:

Patient #15 was admitted to the Emergency Department (ED) on June 12, 2014, at 7:25 p.m., after an assault. Continued review revealed the patient was transferred to another hospital on June 13, 2014, at 2:25 a.m.

Medical record review of an ED physician's assessment sheet dated June 12, 2014, revealed "...assaulted...kicked and hit...dragged...down concrete steps...pain all over...but (greater) in head...ED Physician Diagnoses: Intracranial bleed..."

Medical record review of a diagnostic imaging interpretation dated June 12, 2014, revealed "...CT (computed tomography) head...Impression: 1. Subarachnoid and subdural hemorrhage (head bleed) on the left..."

Medical record review of an ED Nursing Assessment dated June 12, 2014, revealed patient #15 had a neurological assessment completed by a triage nurse at the time of arrival in the ED. Further review revealed no other neurological assessments were documented for the patient.

Interview with the ED Nurse Manager on September 3, 2014, at 4:06 p.m., at the ED nurses station, revealed "...all I see is the initial neuro assessment...no more were done...they should be there....head injuries should have neuro checks every 15 minutes for the first hour and then hourly for 4 hours..." Continued interview confirmed the facility failed to reassess the patient's neurological condition.

Patient #17 was admitted to the ED on May 5, 2014, at 8:33 p.m., for a fever. Continued review revealed the patient was discharged home on May 5, 2014, at 11:15 p.m.

Medical record review of an ED Nursing Assessment dated May 5, 2014, at 9:13 p.m., revealed the patient had a temperature of 102.4 degrees fahrenheit. Continued medical record review revealed no other temperatures were documented for the patient.

Interview with the ED Nurse Manager on September 3, 2014, at 3:55 p.m., at the ED nurses station, revealed "...no they didn't recheck the temperature...would recheck vital signs at time of discharge..." Continued interview confirmed the facility failed to reassess the patient's temperature.

31022

Based on medical record review and interview, the facility failed to ensure entries in the medical record were dated and timed by the physician in eight (#11, #12, #14, #15, #17, #18, #19, and #20) of twenty medical records reviewed.

The findings included:

Patient #11 was admitted to the Emergency Department (ED) on August 31, 2014, for an Asthma Attack. Further medical record review revealed the patient complaint triage (assessment) sheet completed by the ED physician was not dated or timed.

Patient #12 was admitted to the ED on August 28, 2014, for a head injury. Further medical record review revealed the patient complaint triage sheet completed by the ED physician was not dated or timed.

Patient #14 was admitted to the ED on July 31, 2014, for burns to the chest. Further medical record review revealed the patient complaint triage sheet completed by the ED physician was not dated or timed.

Patient #15 was admitted to the ED on June 12, 2014, after an assault. Further medical record review revealed the patient complaint triage sheet completed by the ED physician was not dated or timed.

Patient #17 was admitted to the ED on May 5, 2014, for a fever. Further medical record review revealed the patient complaint triage sheet completed by the ED physician was not dated or timed.

Patient #18 was admitted to the ED on April 4, 2014, after a motor vehicle collision. Further medical record review revealed the patient complaint triage sheet completed by the ED physician was not dated or timed.

Patient #19 was admitted to the ED on March 23, 2014, for a fever. Further medical record review revealed the patient complaint triage sheet completed by the ED physician was not dated or timed.

Patient #20 was admitted to the ED on March 4, 2014, for a nose bleed. Further medical record review revealed the patient complaint triage sheet completed by the ED physician was not dated or timed.

Interview on September 3, 2014, at 1:45 p.m., with the Clinical Coordinator, in the conference room, revealed the patient complaint triage sheet was printed by the triage nurse at time of triage and placed on the chart for the ED physician. Further interview revealed the date and time the triage sheet was printed was identified on the top of the assessment sheet. Continued interview revealed the date and time the ED physician saw the patient was "...not there...we have told them to do it..." Further interview confirmed the facility failed to ensure entries in the medical record for patient #11, #12, #14, #15, #17, #18, #19, and #20 were dated and timed by the physician.