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.

PUTNAM COMMUNITY MEDICAL CENTER 611 ZEAGLER DR PALATKA, FL 32177 Aug. 5, 2013
VIOLATION: CONTENT OF RECORD Tag No: A0449
Based on record review the facility failed for 1 of 5, (Patient #1), to ensure that the medical staff document attempted but failed spinal injections performed.

Findings:

Review of the facility ' s interview with Anesthesiologist #1 revealed that Anesthesiologist #1 attempted three times to perform the spinal injection, (the first two attempts failed). Review of the medical record did not reveal any documentation of the two failed attempts.
VIOLATION: CONTENT OF RECORD - INFORMED CONSENT Tag No: A0466
Based on medical record review the facility failed for 1 of 5, (patient #1), to ensure that properly executed informed consents were completed.

Findings:

1. Review of the medical record revealed Consent for Anesthesia completed for patient #1. The form was signed by the patient and witnessed by the nurse. The form did not include a space for Anesthesiologist #1 to sign. The consent form did not state what kind of anesthesia was going to be performed or that the patient had the risks and benefits explained to her by Anesthesiologist #1. The form did not document the alternatives forms of anesthesia were possible. Review of the medical record did not reveal any other forms of documentation that Anesthesiologist #1 discussed the consent form with the patient #1.

2. Review of the medical fro patient #1 revealed a Consent for Surgical/Invasive Procedure dated 03/16/2013. The consent form described the procedure as "Vaginal delivery-including any repairs of episiotumy or lacerations, or use of a vacuum or forceps to aid with pushing". Review of the consent form revealed the section for the physician's signature indicating that he explained risks and benefits and alternatives were explained to the patient.
VIOLATION: INFECTION CONTROL OFFICER RESPONSIBILITIES Tag No: A0749
Based on observation, staff interview and policy review the facility failed to ensure that infection controls policy and procedures are implemented.

Findings:

1. A Tour of the facility was conducted after the entrance conference. Observation during the tour at 10:58 AM revealed that room 162 was posted for airborne precautions. Observed to the right side of the door revealed a hand sanitizer mounted on the wall. Two HEPA style masks were observed hanging on the hand sanitizer. Additionally, the door separating room 162 and the hall revealed that the door was approximately 5 to 8 inches open.

Interview at 10:58 AM on 08/05/2013 with the administrative representative accompanying this surveyor on the tour revealed that patient occupying the room was in respiratory isolation and that the room was a negative pressure room. The administrative representative stated that for the room to function as a negative pressure room, the door must be completely be closed. The administrative representative stated that it was a breach in infection control practice to hang the masks on the hand sanitizers mounted outside of the patient room.

3. Observation during the tour at 11:05 AM revealed a physician standing in the nursing station working on a computer. A face mask was observed pulled down hanging around the physician ' s neck.

Review of the facility ' s policy and procedure titled SURGICAL ATTIRE IN THE SURGICAL SERVICES revealed on page 2 of 3 section OR ATTIRE WITHIN THE OR SUITE part D. #3 " Masks are either on or off, they must never hang around the neck. "