The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

TANNER MEDICAL CENTER-EAST ALABAMA 1032 MAIN STREET SOUTH WEDOWEE, AL 36278 Sept. 15, 2011
VIOLATION: PATIENT RIGHTS: GRIEVANCES Tag No: A0118
Based on observations, review of policy and procedures and interviews with facility staff, it was determined the Hospital failed to:

1. Post written instructions informing outpatients and emergency room patients of their right to file a complaint with the State agency. This had the potential to affect all patients admitted through the Emergency Department and the outpatient departments.

2. Follow their policy for complaint investigations and resolutions.

Findings include:

1. During a tour of the hospital lobby on 9/13/11 at 10:15 AM it was noted the hospital did not have posted the toll free State hot line number for patients to call to voice grievances.


2. During a tour of the emergency room (ER) on 9/13/11 at 10:30 AM it was noted that the hospital did not have posted the toll free State hot line phone number for patients to call to voice grievances.


During an interview with Employee Identifier (EI) #3, ER manager and EI # 1, Administrator, on 9/13/11 at 3:05 PM, they confirmed the toll free State hot line phone number was not posted.

Facility Policy: Grievance Procedure

Purpose: To provide a systematic and diplomatic way of handling complaints.

Procedure: Any person who believes that he/she... may file a complaint... All persons are encouraged to file grievances in order to resolve any disputes...Your filing of a complaint will not subject you to any form of adverse action, reprimand, retaliation, or otherwise negative treatment by... personnel.

Complaint Processing Procedures are as follows:
A. All complaints... shall be filed first with Departmental Personnel... who shall render an initial determination and resolution within 5 days of receipt of the complaint.

a) If the complainant is not satisfied with the results achieved in Step A, the complainant may file an appeal with...Administrator, who shall render a decision in 5 days.

b) If satisfactory resolution is not achieved in Step b, the complainant may request a hearing with the...Governing Board for a final determination.

5. ...Administrator, shall take steps to insure an appropriate investigation of each complaint to determine its validity. These rules contemplate informal but thorough investigation, affording all interested persons and their representatives, if any, an opportunity to submit evidence relevant to the complaint.

During an interview with Employee Identifier # 1, Administrator, on 9/13/11 at 10:00 AM, he was asked if any complaints had been received in the month of August, 2011. EI # 1 stated that only one complaint had come in the month of August. EI # 1 was then asked for the investigation and if a resolution had been reached.

EI # 1 provided to the surveyor 2 sheets of paper. The first sheet of paper was a complaint received August 26, 2011. The second sheet of paper was information related to the complaint. EI # 1 stated that he had spoken with the complainant by telephone.
" Action taken- this chart will be reviewed at the next performance improvement committee. I (administrator) talked with the provider and ER (emergency room ) manager about this incident. Will follow recommendations of performance improvement committee." Information from second sheet of paper documented by the Administrator on August 30,2011.

On 9/13/11 at 11:00 AM, the surveyor asked EI # 1 for any documentation of interviews with staff regarding the complaint. EI # 1 stated that he did not document them.

On 9/13/11 at 11:00 AM, the surveyor asked EI # 1 when the performance improvement committee was to review the chart. EI # 1 stated that they met the 3rd Wednesday of the month.

The facility failed to document a thorough investigation of the complaint, failed to follow their own policy for complaints and failed to document interviews or chart reviews related to the complaint.
VIOLATION: UNUSABLE DRUGS NOT USED Tag No: A0505
Based on observation, review of policy and procedures and interview with the emergency room manager, the facility failed to assure all medications and biologicals available for patient use in the emergency room (ER) were labeled when opened and safe for use with patients. This included the Trauma room and the ER medication room. This had the potential to adversely affect all patients served by the ER.

Findings include:

Facility Policy: Medication and Solution Container Labeling

Purpose: Labeling of all medications, medication containers, and solutions is a risk reduction activity consistent with safe medication practices.

Procedure:
1. Any time a substance is removed from its original package, the container that any substance is being poured into must contain the name of the substance, strength, amount( if not apparent from the container), expiration date when not used in 24 hours, and expiration time when expiration occurs in less than 24 hours.
2. Labeling occurs at time medication is transferred to new container and medications or solutions are labeled one at a time (Medication is poured or drawn up in syringe, then label applied, then next medication is handled, etc...)
4. All medications found unlabeled should be discarded.
5. At change of shift or break relief, all medications and solutions both on and off the sterile field and their labels are reviewed by entering and exiting personnel.


An initial tour of the Emergency Department was conducted on 9/13/11 at 10:30 A. M. During this tour the surveyors and the ER manger, Employee Identifier # 3 observed the following medications and biologicals with expired dates:

Trauma room in ER: Bacteriostatic 0.9 Sodium Chloride 30 ml(militer) vial opened no date the medication was opened was present on the vial.

Medication room: Lidocaine Hydrochloride oral topical 2% 100 ml opened 1/7/11.

Prednisolone oral solution opened 5/9/11 240 ml bottle.

Bacteriostatic 0.9 Sodium Chloride 30 ml(militer) vial opened no date the medication was opened was present on the vial.

During an interview on 9/13/11 at 10:30 A.M., EI # 3 was asked if the vials and bottles should have been labeled and what was the time frame for use of opened containers. EI # 3 stated that all vials or containers opened were to be labeled with the date and they had a new policy to label with a sticker for the last date it could safely be used. EI # 3 confirmed no labels were present on the containers of the last date of service.
VIOLATION: FACILITIES, SUPPLIES, EQUIPMENT MAINTENANCE Tag No: A0724
Based on observation and interview with Employee Identifier (EI) # 3, the emergency room manager, it was determined the facility failed to assure all medical supplies available for patient use in the emergency room (ER)) were not expired. This had the potential to affect all patients.

Findings include:

1. A tour was conducted on 09/13/11 at 10:30 AM in the ER. During this tour the surveyors and the ER manger observed the following expired supplies:

ED Treatment Room crash cart

Intravenous (IV) tubing 1, expired 6/2010

IV start kits 1, expired October 2008

IV Secure kits 3, expired February 2011

18 gauge needles 11/2 inches 3, expired June 2008.

During an interview on 9/13/11 at 10:30 AM, EI # 3 confirmed the items were out of date and the pharmacist was suppose to check the dates on items in the crash cart.
VIOLATION: CONTENT OF RECORD Tag No: A0449
Based on review of emergency room records and interview with Employee Identifier (EI) # 3, the emergency room manager, it was determined that the emergency room physician failed to:

1. Document the time of his first assessment of the patient in 7 of 11 emergency room records

2. Document the condition of the patient on discharge in 10 of 11 emergency room records where the patient was discharged home or to another facility.

3. Document Physical examination findings in 2 of 11 emergency room records.

Findings include:

1. The following medical record numbers did not have a documented time the physician first assessed the patient: # 1, 0, 9, 5 , 7, 2 and 8.

2. The following medical record numbers did not have a documented condition on discharge: # 1, 0, 9, 5 for 9/9/11 and 9/10/11 (2 visits to bring total to 10 of 11), 7, 2, 4, 0 and 8.

3. The following medical record numbers did not have a documented physical examination: # 0 and 9.

During an interview on 9/13/11 at 2:30 PM, EI # 3 confirmed the items were not present in the records.
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of medical records and interview with Employee Identifier (EI) # 3, the emergency room manager, it was determined the nurses failed to document patient care provided and failed to have a documented physician's order for care rendered to Medical Record (MR) # 5 on two separate occasions at the facility. This had the potential to affect all patients served by this facility.

Findings include:

MR # 5 presented to the emergency room [DATE] at 2:28 PM with a complaint of suprapubic catheter (s/p) was replaced today and no urine out put. Temperature on arrival to ER was 102.3 degrees.

The nurses pertinent history/ initial interview form dated 9/9/11 at 2:47 PM, documented the following information, " Chief complaint- suprapubic catheter not working, abd(abdomen) distended. Nurses notes- ...( Registered Nurse) got s/p cath unstopped. Clot of blood came through it." This information was charted by a Licensed Practical Nurse in the emergency room who triaged the patient.

The physicians orders on the ER form included, " Urinalysis, chemistry profile, complete blood count."

The physician ordered Cipro 250 mg (milligrams) by mouth for identified urinary tract infection, tests results, " Cath (catheter) was readjusted and 200 cc( cubic centimeters) urine output. Small blood clot removed."

The patient was discharged home at 5:00 PM.

During an interview on 9/13/11 at 2:30 PM, EI # 3 was asked how the suprapubic catheter was unstopped. EI # 3 stated that the nurse had to have irrigated the catheter to unclog it, but confirmed there was no documentation of the catheter being irrigated and no order for the nurse to have irrigated it.

MR # 5 presented to the emergency room [DATE] at 7:24 AM with a complaint of suprapubic catheter (s/p) not draining to leg bag, urine is leaking around tubing.

The nurses pertinent history/ initial interview form dated 9/10/11 at 7:24 AM, documented the following information, " Chief complaint- suprapubic catheter not draining to leg bag. Urine is leaking around tubing." Nurses notes- Nothing was documented regarding nurses intervention or care on the form.

The physician's physical exam documented under genitourinary, " Urine noted in suprapubic catheter (deep turbid color)."

The physicians orders on the ER form included, " Rocephin 1 Gram Intramuscular injection."

The physician documented, tests results, " Urinalysis done yesterday- has UTI ( urinary tract infection." Cath (catheter) was readjusted and 200 cc( cubic centimeters) urine output. Small blood clot removed."

Diagnosis- 1. urinary retention 2. UTI, take prescribed medication for UTI, keep appointment with urologist or PCP(primary care physician).

During an interview on 9/13/11 at 2:30 PM, EI # 3 was asked what care was provided to the patient by the nursing staff related to the catheter not draining and leaking around the tubing. EI # 3 stated that she did not know what care the patient received as there was no documentation of care performed and no orders other than the Rocephin injection.