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.

MEMORIAL HERMANN - TEXAS MEDICAL CENTER 6411 FANNIN HOUSTON, TX 77030 Dec. 12, 2019
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record review and interview it was found the facility did not ensure the registered nurses were supervising and evaluating the nursing care in accordance to patients needs in 2 of 5 patient records reviewed (ID# 2, 18).

Findings Included:

Record review of the facility policy "Adult ICU Daily CHG Bathing Procedure", dated 06/11/2019 stated;
All bed-bound patients admitted to intensive care, who are unable to provide self-care will be provided a daily bath using 2% chlorhexidine gluconate (CHG).

Record review of facility policy "Recommended CHG Bathing Practices in the Non-Critical Care Setting" dated 06/18/2019 stated: Bathing Procedure.
Adult patients admitted to the hospital will be bathed daily on all areas of intact skin as tolerated.

Record review and revealed Patient (ID#2) did not receive a bath on 06/02/2019, 06/04/2019-06/06/2019 and was not turned every two hours. The following chart shows the turning and bathing of Patient (ID#2) who was admitted on [DATE] and discharged on [DATE].

Turned W/I 24 hours Bath

06/02/2019-x1
06/03/2019 -x3 Bath
06/04/2019 -Semi Fowlers
06/05/2019-x4
06/06/2019 -Q2 Hours
06/07/2019-x3 Bath


Record review of Patient (ID #18) admitted on [DATE] revealed a paraplegic with a stage 4 decubitus ulcer on sacrum revealed Patient (ID#18) received two baths within a week. Documentation of baths from 12/03/2019-12/10/2019 revealed the following:

12/03/2019
12/04/2019
12/05/2019
12/06/2019 Bath wipes
12/07/2019
12/08/2019
12/09/2019
12/10/2019 Bath, soap & H20

Interview on 12/11/2019 at 1130 with RN, MICU Nurse Manager, (Staff #60) she stated, "we still require patients to be turned every two hours even though the patient are placed on a low pressure beds".

Interview on 12/11/2109 at 1400 with Staff (ID#1), stated it appears they did not get a bath everyday.
VIOLATION: NURSING CARE PLAN Tag No: A0396
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on interview and record review, the facility did not ensure that the nursing staff develops, and keeps current, a nursing care plan for each patient that reflects the patient's goals and the nursing care to be provided to meet the patient's needs, for 4 out of 14 patients (#6, 8, 10. 11).

Findings Included:

Record review of the facilities policy "Electronic Documentation: Interdisciplinary Plan of Care (IPOC)" dated 04/01/2015 stated:
Patient goals will be patient-focused, individualized, measurable, and prioritized bridging the gap between hospitalized and home.
The Interdisciplinary Plan of Care (IPOC) will be initiated on admission and reviewed every 24 hours by the RN and as a patient condition warrants

Record review of patient medical records on 12/11/2019 between 0951- 1130 revealed:
Patient (ID#6) a [AGE]-year-old male was admitted with diabetic keto acidosis (DKA) on an insulin drip. Diabetes was not addressed on the IPOC

Patient (ID#8) a [AGE]-year-old male was admitted for acute sepsis and in end stage renal failure. The IPOC did not address emotional support.

Patient (ID#10) a [AGE]-year-old male admitted with shock and a stage III wound. Wound care was not addressed on the IPOC.

Patient (ID#11) a [AGE]-year-old male admitted with pneumonia, and a history of obesity and anoxic [DIAGNOSES REDACTED]. The IPOC did not address the risk for skin breakdown.

Interview with Nurse Manager, Staff (ID#60) on 12/11/2019 stated:
"these items should definitely be addressed by the nurse in the IPOC, and I do not see it addressed in the record anywhere".