HospitalInspections.org

Based on medical record review, staff interview and policy review it was determined that the Registered Nurse failed to ensure care to all patients was delivered per the physician order and hospital policy. This affected seven (Patient's #1, #2, # 5, # 6, #7, # 8, and #10 ) of ten medical records reviewed. The hospital census was 39.


Findings include:


Review of the Internal Fecal Management System Policy No. 11-PC04-010 (revised 02/2013) states an internal fecal management system is appropriate for use only in patients who are bedridden, decreased level of consciousness, and who have stool that is liquid or semi-liquid. Should also be considered in patients with highly infectious diarrhea, such as clostridium difficile and Vancomycin-resistant entercocci. A physician's order is required and a licensed nurse will insert the rectal tube. Internal fecal management is not intended for use beyond 29 days per facility policy and manufacturers recommendations.


1. Review of the medical record for Patient #1 revealed the patient was admitted on 01/09/16 for diagnosis to include sepsis. The medical record documented a rectal tube was in place from 01/09/16 through 02/26/16. The medical record lacked evidence of a physician's order for placement of the rectal tube. Further, the rectal tube was in place for 49 consecutive days which exceeded the facility policy and manufacturer recommendations of 29 days.


2. Review of the medical record for Patient #2 revealed the patient was admitted on 01/13/16 following cardiac arrest and anoxic brain injury. The patient's diagnoses also included sepsis secondary to a urinary tract infection and a decubitus ulcer of the buttocks. The medical record documented the patient had a rectal tube in place from 01/17/16 through 02/09/16. Staff D confirmed on 06/28/16 at 2:48 PM the medical record lacked evidence of a signed physician's order and/or nursing documentation of insertion of the rectal tube.


3. Review of the medical record for Patient #5 revealed the patient was admitted on 12/22/15 due to acute respiratory failure secondary to multiple gunshot wounds. The medical record documented the patient had a rectal tube in place from 01/25/16 through 01/31/16 and from 02/15/16 through 03/06/16. Staff D confirmed on 06/28/16 at 2:52 PM the medical record lacked evidence of a signed physician's order and/or nursing documentation of the insertion of the rectal tubes.


4. Review of the medical record for Patient #6 revealed the patient was admitted on 01/18/16 for a diagnosis to include respiratory failure. The medical record documented the patient had a rectal tube in place from 02/03/16 through 04/03/16 and from 04/05/16 through 05/22/16. The medical record lacked evidence of signed physician's orders for the placement of the rectal tubes. Further, the rectal tube was in place for 60 consecutive days the first episode and 48 consecutive days the second episode which exceeded the facility policy and manufacturer recommendations of 29 days.


5. Review of the medical record for Patient #7 revealed the patient was admitted to the facility on 02/04/16 for management of respiratory failure. The medical record documented the patient had a rectal tube in place from 02/15/16 through 03/08/16. Staff D confirmed on 06/28/16 at 2:27 PM the medical record lacked evidence of a signed physician's order and/or nursing documentation of the insertion of the rectal tube.


6. Review of the medical record for Patient #8 revealed the patient was admitted to the facility on 06/06/16 following a cerebrovascular accident. The medical record documented the patient had a rectal tube in place from 06/08/16 through 06/10/16. Staff D confirmed on 06/28/16 at 2:05 PM the medical record lacked evidence of a signed physician's order and/or nursing documentation of the insertion of the rectal tube. Staff G stated in an interview on 06/29/16 at 9:30 AM he/she received a verbal order from the physician for rectal tube placement and failed to document the order. A late entry was entered into the medical record on 06/29/16.


7. Review of the medical record for Patient #10 revealed the patient was admitted on 02/28/16 for a diagnosis to include acute respiratory failure. The medical record documented the patient had a rectal tube in place from 02/28/16 through 04/09/16 and from 04/11/16 through 04/17/16. The medical record lacked evidence of signed physician's orders for placement of the rectal tubes. Further, the rectal tube was in place for 40 consecutive days which exceeded the facility policy and manufacturer recommendations of 29 days.


Staff A stated in an interview on 06/29/16 at 8:40 AM he/she was unaware of the facility policy and/or the manufacturer recommendation for rectal tubes not exceeding 29 days. Staff A gives a verbal order to nursing staff with the expectation the order will be transcribed into the medical record. Review of the Policy No. H-IM 02-021 PRO for Differentiation between Verbal and Written orders states to make a notation of the order in the electronic medical record as the order is received.

Based on medical record review, staff interview and policy review the facility failed to ensure physician orders were obtained prior to insertion of rectal tube and or discontinuation of the rectal tube. This affected seven (Patient's #1, #2, # 5, # 6, #7, # 8, and #10 ) of ten medical records reviewed. The hospital census was 39.


Findings include:


Review of the Internal Fecal Management System Policy No. 11-PC04-010 (revised 02/2013) states a physician's order is required and a licensed nurse will insert the rectal tube. Internal fecal management is not intended for use beyond 29 days per facility policy and manufacturers recommendations.


1. Review of the medical record for Patient #1 revealed the patient was admitted on 01/09/16 for diagnosis to include sepsis. The medical record documented a rectal tube was in place from 01/09/16 through 02/26/16. The medical record lacked evidence of a physician's order for placement of the rectal tube.


2. Review of the medical record for Patient #2 revealed the patient was admitted on 01/13/16 following cardiac arrest and anoxic brain injury. The patient's diagnoses also included sepsis secondary to a urinary tract infection and a decubitus ulcer of the buttocks. The medical record documented the patient had a rectal tube in place from 01/17/16 through 02/09/16. Staff D confirmed on 06/28/16 at 2:48 PM the medical record lacked evidence of a signed physician's order for placement of the rectal tube.


3. Review of the medical record for Patient #5 revealed the patient was admitted on 12/22/15 due to acute respiratory failure secondary to multiple gunshot wounds. The medical record documented the patient had a rectal tube in place from 01/25/16 through 01/31/16 and from 02/15/16 through 03/06/16. Staff D confirmed on 06/28/16 at 2:52 PM the medical record lacked evidence of a signed physician's order for placement of the rectal tubes.


4. Review of the medical record for Patient #6 revealed the patient was admitted on 01/18/16 for a diagnosis to include respiratory failure. The medical record documented the patient had a rectal tube in place from 02/03/16 through 04/03/16 and from 04/05/16 through 05/22/16. The medical record lacked evidence of signed physician's orders for the placement of the rectal tubes.


5. Review of the medical record for Patient #7 revealed the patient was admitted to the facility on 02/04/16 for management of respiratory failure. The medical record documented the patient had a rectal tube in place from 02/15/16 through 03/08/16. Staff D confirmed on 06/28/16 at 2:27 PM the medical record lacked evidence of a signed physician's order for the placement of the rectal tube.


6. Review of the medical record for Patient #8 revealed the patient was admitted to the facility on 06/06/16 following a cerebrovascular accident. The medical record documented the patient had a rectal tube in place from 06/08/16 through 06/10/16. Staff D confirmed on 06/28/16 at 2:05 PM the medical record lacked evidence of a signed physician's order and/or nursing documentation of the insertion of the rectal tube. Staff G stated in an interview on 06/29/16 at 9:30 AM he/she received a verbal order from the physician for rectal tube placement and failed to document the order. A late entry was entered into the medical record on 06/29/16.


7. Review of the medical record for Patient #10 revealed the patient was admitted on 02/28/16 for a diagnosis to include acute respiratory failure. The medical record documented the patient had a rectal tube in place from 02/28/16 through 04/09/16 and from 04/11/16 through 04/17/16. The medical record lacked evidence of signed physician's orders for placement of the rectal tubes.


Staff A stated in an interview on 06/29/16 at 8:40 AM he/she was unaware of the facility policy and/or the manufacturer recommendation for rectal tubes not exceeding 29 days. Staff A gives a verbal order to nursing staff with the expectation the order will be transcribed into the medical record. Review of the Policy No. H-IM 02-021 PRO for Differentiation between Verbal and Written orders states to make a notation of the order in the electronic medical record as the order is received.