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.

WELLMONT BRISTOL REGIONAL MEDICAL CENTER ONE MEDICAL PARK BLVD BRISTOL, TN 37620 Aug. 22, 2013
VIOLATION: NURSING CARE PLAN Tag No: A0396
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on medical record review, observation, review of facility policy and interview, the facility failed to ensure an accurate plan of care, related to dialysis, for two patients (#1, #8), of eight patients reviewed.

Medical record review revealed patient #1 was admitted to the facility on on [DATE], with diagnoses including End Stage Renal Disease and [DIAGNOSES REDACTED] (disorder of the brain). Further medical review revealed the patient was dialysis dependent.

Medical record review of the "Interdisciplinary Care Coordination Round and Daily Plan of Care" for patient #1, dated August 18, 2013, revealed no documentation of the patient's dialysis.

Medical record review revealed patient #8 was admitted to the facility on on [DATE], with diagnoses including Acute Renal Failure. Further review revealed the patient was dialysis dependent.

Medical record review of the Interdisciplinary Care Coordination Round and Daily Plan of Care", for patient #8, dated March 29, 2013, revealed no documentation of the patient's dialysis.

Interview with RN #2, on August 20, 2013, at 11:45 a.m., in the Hemodialysis Unit, revealed "...the care plans are kept on the unit and we do not see the care plan...we do not update the care plans in the dialysis..."

Interview with RN #6, on August 21, 2013, at 8:40 p.m., on the Immediate Care Unit revealed, "...the patient's care plan is started on admission and updated as needed by the nurses or other staff members...the care plan is kept on the unit...would update the care plan according to the patient's history and needs...if the patient is on dialysis the care plan should reflect..."

Review of facility policy, Interdisciplinary Plan of Care, revised July 12, 2010, revealed, "...on admission, the Registered Nurse will be responsible for initiating the Interdisciplinary Plan of Care...the plan of care will be inclusive of problems identified through the admission assessment process..."

Interview with the Nurse Manager, on August 20, 2013, at 2:30 p.m., in the conference room, confirmed the care plans for patient #1 and patient #8 were not complete and did not reflect the need for dialysis.

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VIOLATION: PHARMACY ADMINISTRATION Tag No: A0491
Based on observation, review of facility policy, and interview, the facility failed to ensure proper labeling of medications in the Inpatient Dialysis Unit.

The findings included:

Observation on August 20, 2013, at 11:30 a.m., in the Inpatient Hemodialysis Unit (HDU), revealed two (3cc) unlabeled syringes lying on the bedside table where patient #1 was receiving dialysis. Further observation revealed the syringes were filled with a clear fluid and had a red needle cover on the end of the syringes.

Interview with RN #4, on August 20, 2013, at 11:30 a.m., in the HDU, revealed "...the syringes have Heparin in them...drew them up myself and have been in my presence...the syringes are not labeled..."

Interview with RN #3, on August 20, 2013, at 11:31 a.m., in the HDU, revealed "...we need to label those...have Heparin (500unit/ml)in the syringe..."

Review of facility policy, Drug Security and Labeling, last revised February 2012, revealed "...all medications prepared for administration, but not immediately used, must be labeled...at a minimum, this labeling must include drug name, strength, expiration date if not used within 24 hours..."

Interview with the Nurse Manager, on August 20, 2013, at 11:35 a.m., in the HDU, confirmed the syringes were not labeled and the facility failed to follow policy for drug security and labeling.

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VIOLATION: SECURE STORAGE Tag No: A0502
Based on observation and interview, the facility failed to secure biologicals and storage of chemicals.

The findings included:

Observation on August 20, 2013, at 10:30 a.m., in the water room of the Hemodialysis Unit (HDU), revealed a large shelf with three separate storage shelves. Further observation revealed the top and middle shelf contained several large bottles of Dialysate solution (chemical bath solution used during dialysis) and one box of Sodium Bicarbonate (used during the dialysis procedure). Further observation revealed on the bottom shelf of the storage container, one gallon container labeled "bleach".

Interview with RN #2, on August 20, 2013, at 10:35 a.m., in the water room of the HDU, revealed "...the Dialysate and Sodium Bicarbonate are used during the dialysis procedure on every patient...these are stored in the water room where we have access to the Dialysate...do not know why bleach is stored in the room...for cleaning the dialysis machines..."

Interview with the Nurse Manager on August 20, 2103, at 10:40 a.m., in the water room of the HDU, confirmed the bleach was stored on the same shelves where the Dialysate is stored and the bleach was not stored appropriately.

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