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.

ERLANGER MEDICAL CENTER 975 E 3RD ST CHATTANOOGA, TN 37403 March 1, 2018
VIOLATION: STAFFING AND DELIVERY OF CARE Tag No: A0392
Based on policy review, record review, and interview, the facility failed to ensure a physician's order was obtained prior to the removal and insertion of a urinary catheter (a tube placed into a patient's bladder to drain urine) for one patient (#11) of 28 patients reviewed.

The findings included:

Review of policy titled "Urinary Catheters, Management and Care of" last revised date April 2017, revealed "...A physician's order is required for all catheter insertions..."

Medical record review revealed Patient #11 was admitted to the Emergency Department (ED) on 5/18/16 at 6:25 PM for complaint of "...placement of supracatheter [urinary catheter insertion through an incision in the abdomen] yesterday...catheter came out..."

Medical record review of a physician's note dated 5/18/16 at 7:56 PM revealed "...multiple strictures has indwelling foley [catheter] and suprapubic. Suprapubic came out a couple hours ago. Site appears intact...will replace 14 fr [French] [size of the catheter] foley..." Further review a physician's note at 9:44 PM revealed an order for a "...14 french foley catheter..." Continued review revealed no physician's order for removal of the 18 fr indwelling penile catheter.

Review of a nurse's note dated 5/18/16 at 9:00 PM revealed "...Indwelling 18 fr penile catheter removed...Pt [patient] then stated that catheter was placed during surgery and was not the one that was the problem. New 18 fr catheter obtained...inserted into penis, no pain, no resistance...urine present and clear, amber..."

Interview with the Emergency Director on 2/21/18 at 2:30 PM, in the ED, confirmed there was not a physician's order for the removal and replacement of Patient 11's urinary catheter on 5/18/16 and an order was required for removal or insertion of a urinary catheter.
VIOLATION: ORGANIZATION Tag No: A0619
Based on facility policy review, observations, and interview, the facility failed to follow safe food handling and storage practices in 1 of 1 dietary kitchens observed.

The findings included:

Review of facility policy "Operational Standard: SANITATION PROGRAM" effective date 8/31/15 revealed "...maintain a clean, safe and effective environment of care...Equipment, walls, floors and storage areas are routinely cleaned..."

Review of facility policy "...Food Safety..." effective date 8/31/15 revealed "...Storing Prepared Food...Labels Required...Date of preparation and/or use-by date...Food left over after meal service: Use within 2 days..."

Observation and interview with the Food Manager on 2/21/18 at 3:00 PM, of the kitchen, revealed a cleaned food mixer with dried food debris on the body, blades, and drive shaft. Interview with the Food Manager confirmed the food mixer was clean and ready for use. Further interview confirmed the food mixer had dried food debris visible on the mixer's body, blades, and drive shaft.

Observation and interview with the Food Manager on 2/21/18 at 3:03 PM, of the baker's walk-in refrigerator in the kitchen, revealed the fan covers had a large build-up dust and lint on them. Interview with the Food Manager confirmed the fan covers had a large build-up of dust and lint on them.

Observation and interview with the Food Manager on 2/21/18 at 3:05 PM, of the kitchen dry storage room, revealed a large build-up of dust, lint, and litter visible on the floor under the food shelves. Interview with the Food Manager confirmed there was a large build-up of dust, lint, and litter on the floor.

Observation and interview with the Food Manager on 2/218/18 at 3:10 PM, of the kitchen walk-in refrigerator #5, revealed a large pan of cooked elbow macaroni, a large container of soup, a large container of cooked bacon, all without storage dates documented on the containers or covers. Further observation revealed the storage shelves had dried debris visible on them. Interview with the Food Manager confirmed the containers of elbow macaroni, soup, and bacon were not labeled with storage dates documented on the container or cover. Further interview confirmed all stored prepared food must be dated.

Observation and interview with the Food Manager on 2/21/18 at 3:15 PM, of the kitchen, revealed a 6 metal serving pans stored wet on a metal rack. Further observation revealed the metal rack had visible dried debris on the shelves. Interview with the Food Manager confirmed the serving pans were clean and ready for use. Continued interview confirmed the pans were stored wet and the metal rack had dried food debris on the shelves.