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.
|JOHNSON CITY MEDICAL CENTER||400 N STATE OF FRANKLIN RD JOHNSON CITY, TN 37604||Aug. 4, 2014|
|VIOLATION: INFECTION CONTROL OFFICER RESPONSIBILITIES||Tag No: A0749|
|Based on medical record review, observation, review of facility policy, and interview, the facility failed to follow infection control precautions during urinary catheter care for one patient (#1) of five patients reviewed.
The findings included:
Patient #1 was admitted to the facility on on July 26, 2014, after a motor vehicle accident with a diagnosis of a Subarachnoid Hemorrhage.
Medical record review revealed a urinary catheter was inserted on July 26, 2014, and the patient was admitted to the Intensive Care Unit.
Observation on July 28, 2014, at 5:00 p.m., in the patient's room in the Intensive Care Unit, revealed Registered Nurse (RN) #1 performing urinary catheter care for the patient. Further observation revealed the RN donned gloves and wiped the patient's perineal area from back to front during the care with a clean wash cloth. Continued observation revealed the RN used the same soiled wash cloth and wiped the patient's perineal area again from back to front. Further observation revealed the RN opened a drawer and retrieved a prepackaged CHG wipe (used for the prevention of Urinary Tract Infections) without changing the soiled gloves, opened the prepackaged CHG wipe, and cleaned the urinary catheter without changing the gloves or sanitizing the hands.
Review of facility policy Urinary Catheter: Indwelling Catheter Care, not dated, revealed, "..for females gently retract the labia to fully expose urethral meatus and catheter insertion site...maintain position of hand throughout the procedure...bacterial growth is common where the urinary catheter enters the urethral meatus in both men and women...perform catheter care each shift as post of routine perineal care..."
Interview with RN #1 on July 28, 2014, at 5:15 p.m., in patient #1's room, confirmed the nurse cleaned the patient's perineal area from back to front two times with the wash cloth. Further interview confirmed the nurse obtained the CHG wipes from the clean drawer using the soiled gloves and cleaned the patient's urinary catheter with the soiled gloves.
Interview with the Infection Control Preventist on July 29, 2014, at 8:30 a.m., in the conference room, confirmed the nurse failed to follow standard infection control practices during the urinary catheter care.
|VIOLATION: REASSESSMENT OF A DISCHARGE PLAN||Tag No: A0821|
|**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on medical record review, observation, and interview, the facility failed to have an accurate discharge plan which included Discharge Medication Reconciliation for one patient (#7) of eleven patients reviewed.
The findings included:
Patient #7 was admitted to the facility on on [DATE], for a total knee replacement and the patient was discharged to a Skilled Nursing Facility on February 10, 2014.
Medical record review of an admission history and physical dated February 5, 2014, at 3:33 p.m., revealed "...patient long history of right knee osteoarthritis...has failed conservative treatment and elected for right knee replacement...medical history...heart with an [DIAGNOSES REDACTED], atrial fibrillation, leaky valve and hypertension...the patient has elected for right total knee replacement...will continued following the patient throughout the hospital course...the patient has been medically cleared by her primary care physician..."
Medical record review of a consultation report dated February 5, 2014, at 1:00 p.m., written by the Hospitalist, revealed, "...presents for total knee replacement and consulted for medical management...medications: Pardaxa (blood thinner) 150mg (milligrams) twice a day, Digoxin (medication used to slow the heart rate down) 250mcg (micrograms) daily, Diltiazem (medication used to control the blood pressure and heart rate) 120mg daily, Lasix (diuretic) 40mg twice a day, Potassium Chloride (medication used for potassium replacement) 20 mEq (milliequivalents) daily, Salsalate (anti-inflammatory medication) 750mg three times a day, Sotalol (medication used to control cardiac arrhythmias) 120mg daily, and Trazodone (medication used for depression) 100mg at bedtime...plan...for hypertension we will continue with the beta blocker with holding parameters...that will begin tomorrow on the 6th, and we will resume her Lasix on the 6th or 7th depending on how she is doing...this plan of care was outlined with the patient and the patient's husband...they are agreeable..."
Medical record review of the Admission Medication Reconciliation Report dated February 5, 2014, at 1:57 p.m., revealed "...Lasix 40mg twice a day...not continued..."
Medical record review of a Physicians Progress note dated February 7, 2014, at 11:20 a.m., written by the Hospitalist, revealed, "...on Lasix at home...on hold at this time..."
Medical record review of a Physicians Progress note dated February 9, 2014, at 8:15 a.m., written by the cardiologist, revealed "...Lasix 40mg BID (twice a day)...restart 1x day..."
Medical record review of an electronic Physicians Order sheet dated February 9, 2014, at 8:31 a.m., written by the patient's Primary Care Physician, revealed "...Lasix 40mg x 1 daily..."
Medical record review of the Discharge Medication Administration Record dated February 9, 2014, at 8:31 a.m., revealed "...Lasix 40mg one tablet one time a day..."
Medical record review of the Nursing Assessment Reports revealed the patient's weights were as follows: February 5, 2014, 75kg (kilograms) [165 pounds]; February 9, 2014, 92 kg [202 pounds].
Medical record review of the Doctors Order Sheet Medication Transfer Form revealed the transfer form was printed off by the 600 Nursing Unit on February 7, 2014, at 4:39 p.m. Further medical record review revealed the telephone order from the discharging physician received by Registered Nurse (RN) #10 on February 10, 2014, at 11:49 a.m., revealed no physician's order for Lasix.
Interview with RN #10 on July 29, 2014, at 3:00 p.m., in the conference room, revealed the nurse was working the day the patient was discharged from the facility to the Skilled Nursing Facility (February 10, 2014). Further interview revealed the nurse spoke with the patient's discharging physician and confirmed the medications on the Discharge Medication Reconciliation Sheet which was dated February 7, 2014. Further interview revealed "...the medications on the form were given to the physician by telephone and I wrote the telephone order to continue the medications...Lasix was not on the reconciliation sheet that I spoke with the physician about..." Further interview revealed "...the patient was receiving Lasix on February 10, 2014..."
Interview with the CNO on July 29, 2014, at 2:15 p.m., in the conference room, revealed "...the Lasix and Potassium was held on admission due to the patient's blood pressure being low...the patient was started back on the Lasix on February 9, 2014, and given as ordered by the physician..."
Interview with the Nurse Manager for the 600 Wing Unit on July 29, 2014,at 2:30 p.m., in the conference room, revealed "...the reconciliation form for the patient was printed off on February 7, 2014, when the patient was anticipated to be discharged from the facility...the patient had some issues with a fast heart rate and...discharge was postponed until the patient was medically stable..." Continued interview revealed "...the Discharge Medication Reconciliation Sheet should have been reprinted on February 10, 2014, but it was not, so the discharge medication reconciliation form only showed the medications from February 7, 2014...therefore the Lasix was not written on the discharge medication form .." Further interview confirmed the Lasix was not continued on the Discharge Medication Reconciliation Sheet as ordered by the physician and the facility failed to perform an accurate discharge plan for the patient.