HospitalInspections.org

Based on record review and interview, the facility failed to ensure nursing staff administered medication under accepted standards of practice for 1 (#1) of 1 patients out of a total of 7 sampled patients reviewed for medication, resulting in the potential for poor patient outcomes. Findings include:

On 2/6/18 at approximately 1300, review of patient #1's medical record was conducted with the Director of Nursing Staff A.

A review of the medical record revealed patient #1 was admitted to the facility on 12/8/17 with diagnoses that included acute respiratory failure.

A review of physician orders for medication administration for patient #1 included the following:

On 12/10/17 through 12/16/17, Immodium 2-4 milligrams (mg) (used to treat and control diarrhea) four times per day as needed diarrhea.
On 12/12/17 through 12/17/17, Lomotil 5 mg (used to treat and control diarrhea) four times per day by mouth as needed.
On 12/14/17 "GoLytely" (laxative solution) used to clean the bowel in preparation for a colonoscopy.
On 12/14/17 physician orders documented, "NPO (nothing by mouth) after midnight for colonoscopy on 12/15/17.

A review of the patient's medication administration records (MAR's) dated 12/14/17 through 12/19/17 documented the following:
On 12/14/17 at 1942 the "GoLytely" solution was started.
On 12/15/17 at 0106 the patient was administered Lomotil 5 mg.
On 12/15/17 at 0600 the patient was administered Lomotil 5 mg.
On 12/15/17 at 1439 the patient was administered Lomotil 5 mg.

A review of physician progress notes dated 12/15/17 and 12/16/17 documented the patient's colonoscopy was not performed due to the poor preparation for the procedure (large amount of stool in bowel).

A review of nursing progress notes dated 12/14/17 through 12/15/17 revealed there was no evidence that documented the physician was contacted regarding the patient's status. There was no evidence that documented the physician was contacted on whether or not to continue or hold the Lomotil during the colonoscopy preparation.

At that time Staff A was asked to explain if the patient should have received the Lomotil while receiving the laxative solution for the colonoscopy preparation. Staff A said the nurse should have contacted the medical doctor for clarification.

On 2/7/18 at approximately 1315 an interview and record review was conducted with the Director of Pharmacy Staff J. When queried regarding the "GoLytely" preparation and the administration and the use of anti-diarrhea's concurrently, Staff J explained that the anti-diarrhea's should probably not have been given during the preparation. She said that would have been a nurse to physician call or communication. Staff J explained pharmacy would not have triggered an alert for potential contraindication.

On 2/7/18 at 1400 a review of the manufacturer's recommendations documented the following:
"GoLytely" is an oral solution that prepares a patient for a colonoscopy. The solution will help to cleanse the bowel before the procedure and allow the doctor to see the inner section of the patient's colon. The solution is drunk every 10 minutes until the bowel are watery and clear
How does it work? "GoLytely" stimulates diarrhea to trigger the colon cleansing process. The liquid solution usually works in 4 hours within taking it.

Based upon observation and interview the facility failed to ensure a sanitary environment to prevent the transmission of infectious agents. This deficient practice could potentially affect all inpatients. Findings include:

On 02/06/2018 between the hours of 900 and 1600 observed poor house keeping and heavy grime build-up noted at the following various locations including but not limited to:

1. Behind the main corridor fire control doors (east corridor);

2. Door frames to central bathing room and to dialysis supplies storage room;

3. Under the wire shelving unit at the dialysis supplies storage room; and

4. Above compounding hood and cabinets (high surfaces) in pharmacy room

Above findings were confirmed by accompanying staff A and B at the time of the observation.

Based on interview and record review, the facility failed to ensure the Rehabilitation Care Coordinator Physical Therapist Assistant (PTA) Staff G maintained personnel qualifications in accordance with national acceptable standards of practice, resulting in the potential for poor patient outcomes. Findings include:

On 2/7/18 at approximately 1040 an interview was conducted with Staff G. According to Staff G she was the Clinical Coordinator (CC) for the Rehabilitation program. She said she was a PTA. She explained she reported to the Rehab Program Director. Staff G said she been employed for 2 years and had been in her current role since September 2017.

A review of the medical record for patient #1 was conducted with Staff G at that time. Staff G explained she recalled providing care and services for patient #1. She said she recalled the patient required mid-minimal assistance with bed mobility and transfers to chair and bed. She said she recalled the patient was only able to go to the "Gym" on one occasion. She said the patient received the remainder of his rehab sessions in his room due to concerns related to infection control prevention.

On 2/7/18 at approximately 1245 Staff G's personnel file was requested from the Director of Quality Staff M. Staff M explained the employees files were kept off site and the requested documents (license, training for current role/responsibilities, competencies. performance evaluations and job description) would be copied and provided electronically.

On 2/7/18 at approximately 1600 Staff M explained she was still waiting for the Staff G's personnel records.

A review of Staff G's personnel file on 2/7/18 at 1645 revealed Staff G's date of hire was 12/2015 as a PTA There was no evidence that documented Staff G had received training for her role for the CC. The only competencies documented in Staff G's personnel file were dated on a form titled "Annual Skills 2017". Competencies were only documented for oxygen therapy, pulse oximeter and a checklist for infection control. There were no current competencies documented for gait training, transfer skills or therapeutic exercises. There was an undated, unsigned performance evaluation in the file.

A review of the job description for CC documented:
Summary Statement:
"The incumbent shall be responsible for providing therapy services including assessment, treatment planning and therapeutic interventions in an interdisciplinary environment consistent with the discipline's qualification, professional practices and ethical standards. The incumbent shall also be accountable for and contribute to program development, quality improvement, problem solving, and productivity enhancement in a flexible interdisciplinary fashion. The incumbent shall be accountable for carrying out all responsibilities in accordance with (name of contracted rehab company) CORE values."

On 2/7/18 at 1645 the Chief Executive Officer Staff K was informed of the aforementioned concerns. When asked to explain why there was no evidence that documented Staff G had received training for her current role as CC and why there was no further evidence that documented Staff G's competencies for her current role or a current performance evaluation, Staff K said the (name of contracted rehab) company was responsible for those services. When asked to provide further evidence that documented Staff G was qualified to perform her role as the CC Staff K offered no further explanation.

A review of the contract for the Rehabilitative Services department dated 2/1/2014 documented the following:
1. Duties and Obligations of (name of contracted company).
a. Services: (name of contracted company) shall provide Rehabilitation Services to patients of hospital at the (name of campus) pursuant to this Agreement upon receipt of the written order of an attending physician.
b. Qualified Personnel: (name of contracted company) shall employ or engage qualified personnel to deliver the Rehabilitation Services of the hospital pursuant to this aggreement(name of contracted company will make available to hospital for its file copies of credentials and qualification of the Therapists..., to include current licenses, registrations and/or certifications and annual performance evaluations.

2. Duties and Obligations of Hospital:
a. Professional Services: Hospital is responsible for obtaining services that meet the professional standards and principles that apply to professionals providing services at the (name of campus), the timeliness of the services, and the overall management and care of its patients.
b. Supervision and Control: Hospital shall be primarily responsible for maintaining supervision and control over the therapists providing Rehabilitation Services to patients of Hospital and at the (name of campus).