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.

MILTON S HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Nov. 10, 2016
VIOLATION: INFECTION CONTROL OFFICER RESPONSIBILITIES Tag No: A0749
Based on a review of facility policy and staff interview (EMP), it was determined that the facility failed to ensure that staff did not wear artificial nails.

Findings include:

A review of facility policy "Personal Appearance Guidelines" last revised May 2014, revealed, "...C. Any Health Care Worker (HCW), including physicians, whose job includes hands on direct patient care or assessment, medication or food preparation, handling or processing of equipment and/or supplies used on patients may not wear artificial fingernails or artificial nail products. These products include but are not limited to artificial nails, nail jewelry, overlays, wraps, weaves, gels, and extensions. HCW's who wear artificial nails are more likely to harbor pathogens on their fingertips than are those who have natural nails."

An interview conducted on November 10, 2016, at 11:00 am with EMP6 confirmed EMP10, was wearing artificial nails back in December of 2014. EMP6 confirmed that a verbal warning was given to EMP10, on December 10, 2014, regarding the use of artificial nails. EMP6 also confirmed that EMP10, was providing direct patient care on November 9, 2016, and was wearing artificial nails. EMP6 confirmed that EMP10 was given a second verbal warning.
VIOLATION: RESPIRATORY CARE SERVICES POLICIES Tag No: A1160
Based on a review of medical records (MR) and staff interview (EMP), it was determined the facility failed to deliver services in accordance with medical staff directive by adjusting the ventilator setting when the physician requested no changes to the ventilator for one of one medical record reviewed (MR1).

Findings include:

A review on November 10, 2016, of MR1, revealed the following Respiratory Therapy note dated, October 11, 2016, at 11:00 am, "Per Dr. {name redacted} in AM rounds, no ventilator changes are to be made within the next 48 hours without his consent."

Further review of MR1 revealed a respiratory therapist lowered the vent alarm from 60 to 55 on October 12, 2016 at 4:35 am. Further review of the medical record revealed the over the next four hours, the oxygen saturation continued to drop to 89-91%. At 8:40 am on October 12, 2016, the patient required bag valve mask ventilation for a few minutes.

An interview conducted on November 10, 2016, at 8:30 am with EMP4 confirmed the respiratory therapist lowered the alarm setting from 60 to 55 and did not notify the physician of the change.

An interview conducted on November 10, 2016, at 8:40 am with EMP5 confirmed that there was mis-communication with the oncoming therapist. EMP5 confirmed the therapist should have contacted EMP5 prior to making any adjustments to the ventilator settings.