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.

GEISINGER MEDICAL CENTER 100 NORTH ACADEMY AVENUE DANVILLE, PA 17822 Dec. 26, 2019
VIOLATION: NURSING CARE PLAN Tag No: A0396
Based on a review of facility documents, medical records (MR), and staff interview (EMP) it was determined the facility failed to ensure that Physician Ordered daily weights were obtained for two of two medical records reviewed (MR1 and MR3).

Findings include:

A request was made for the facility policy regarding obtaining daily weights. No policy was provided.

Interview on December 26, 2019, with EMP4, at approximately 10:30 AM, revealed the facility does not have a policy for obtaining daily weights. EMP4 revealed MR1's order for daily weights was a physician order to be followed by nursing staff.

A request was made for the facility policy regarding staff completion of physician orders. No policy was provided

Interview on December 26, 2019, with EMP4, at approximately 10:45 AM, revealed the facility does not have a policy regarding the completion of physician orders. EMP4 revealed it is expected staff complete physician orders.

Review on December 23, 2019, of MR1 revealed the patient was ordered daily weights on October 8, 2019. There was no documentation for patient's daily weight for October 9, 10, 11, 13, 14, 16, 20, 2019.

Interview on December 23, 2019, with EMP2, at approximately 11:00 AM, confirmed there was no documentation of MR1's daily weight was obtained for October 9, 10, 11, 13, 14, 16, 20, 2019.

Review on December 26, 2019, of MR3 revealed patient was ordered daily weights on October 12, 2019. There was no documentation MR3's daily weight was obtained on October 12, 13, 14, 24, and 25, 2019.

Interview on December 26, 2019, with EMP2, at approximately 12:30 PM, confirmed there was no documentation MR3's daily weight was obtained October 12, 13, 14, 24, and 25, 2019.
VIOLATION: RESPIRATORY SERVICES Tag No: A1164
Based on a review of facility documents, medical records (MR), and staff interview (EMP) it was determined the facility failed to ensure incentive spirometry was provided as per the physician order for two of two medical records reviewed (MR1 and MR2).

Findings include:
Review on December 23, 2019, of the facility's policy, "Incentive Spirometry," last reviewed May 7, 2019, revealed "Purpose: This policy establishes guidelines for the administration of Incentive Spirometry ... Policy: Sustained Maximal Inspiration is maneuver taught to the patient by the Respiratory Care staff, and supplemented by the use of a goal oriented device-Incentive Spirometer. A physician's order must specify Incentive Spirometry (cough and deep breath will not be acceptable), with or without a PDP order. The patient will receive one initial instructional; visit and will receive followup [sic] visits as clinically appropriate. I.S. devices will not be issued to patients with an artificial airway. Indications: Patients prone to develop atelectasis due to preexisting lung disease, smoking history, chest trauma, postoperative state (thoracic or abdominal surgery), muscular weakness, or retained pulmonary secretions. ... Responsibilities: 1. Respiratory Care Services Staff (CRT, RRT). 2. Nursing Staff (RN, LPN, Nursing Assistants) will reinforce patient use. Equipment/Supplies: 1. I.S. device Procedure: The patient will receive an initial instructional visit and will receive followup [sic] visits as indicated. Patients will be instructed to perform I.S. Q1H W/A. Nursing staff is expected to encourage patient use between Respiratory Care visits. GMC-Danville post-op nursing staff will issue and educate patients on stand-alone incentive spirometry administration. ... ."


Review on December 23, 2019, of the facility's policy, "Documentation of Respiratory Care Provision of Services," last reviewed October 7, 2019, revealed "Purpose: This Documentation of Respiratory Care Provision of Services policy and procedure establishes guidelines for method and location of documentation of all services provided by Respiratory Care Services. Persons Affected: Physicians, Physician extenders, Respiratory Care Services staff, Nursing staff, Pharmacy staff, Medical Records staff. Policy: All Respiratory Care Services provided to a patient require accurate, consistent, and complete documentation as part of the patient's medical record. It is essential for: (1) physicians to acknowledge the service provided to assess the status of the patient's progress, (2) legal documentation of services, (3) verification for reimbursement of services rendered. Electronic documentation via [electronic medical record system] is the primary method of documenting Inpatient information. Manual documentation in the medical record should only be performed on procedures initiated in areas where electronic documentation is not available. ... Responsibilities: Respiratory Care Services Staff (CRT, RRT) will document all procedures and patient encounters within their scheduled shift. (see procedure for specifics). ... Procedure: Electronic charting utilizing the Respiratory Module-Respiratory Notes, Ancillary Progress Notes, and Flowsheets in [electronic medical record system] will be performed for all Respiratory Care therapeutic and diagnostic modalities. ... ."


Review on December 23, 2019, of MR1 revealed patient was ordered incentive spirometry every shift on October 15, 2019. There was no documentation MR1 received incentive spirometry or any respiratory treatments October 16, 17, and 18, 2019.

Interview on December 23, 2019, with EMP2 and EMP3, at approximately 2:00PM confirmed there was no documentation MR1 received incentive spirometry or any respiratory treatments October 16, 17, and 18, 2019.

Review on December 26, 2019, of MR2 revealed patient was ordered Incentive Spirometry every hour on October 15, 2019. There was no documentation MR2 received Incentive Spirometry October 15, 16, 17, 18, 2019.

Interview on December 26, 2019, with EMP2, at approximately 1:00 PM confirmed MR2 was ordered Incentive Spirometry on October 15, 2019 and there was no documentation MR2 received the Incentive Spirometer device or treatment October 15, 16, 17, 18, 2019.