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Based on observation, interview and policy review, the hospital failed to:
- Remove expired patient care supplies;
- Clean the surface and base of the sexual assault nurse examiner (SANE, a registered nurse or nurse practitioner who has completed specialized training to assist sexual assault victims and collect all forensic evidence and perform exams) supply cart and shelving bins located in the clean utility room;
- Remove outdated supplies from the emergency Obstetrics (OB, the branch of medical science concerned with childbirth and caring for and treating women in or in connection with childbirth) cart;
- Clean the dry food bins; and
- Laminate paper hung on the walls to create a cleanable surface.

Findings included:

1. Review of the hospital's undated policy titled, "Distribution Inventory Process for Supply Chain Managed Inventory Locations: Systems," showed Supply Chain Staff managed inventories. The Supply Distribution Department maintains the expiration date monitoring and stock rotation.

Observation on 09/10/24 at 10:05 AM, in the Emergency Department (ED) medication room two, showed one box of surgical masks with an expiration date of 01/01/24.

Observation on 09/10/24 at 9:55 AM, in medication room one, showed one port-a-cath (a small medical appliance installed beneath the skin in the chest region and connects the port to a vein and is used to administer medications and draw blood) access needle expired on 06/30/24 and 22 opened oral syringes.

Observation on 09/10/24 at 9:15 AM, in the clean utility room, showed 57 opened gastrostomy tube (G-tube, soft, flexible tube inserted through the skin of the abdomen and into the stomach) syringes with no expiration date.

During an interview on 09/10/24 at 9:44 AM, Staff D, ED Assistant Nurse Manager, stated that she agreed the supplies were expired and did not belong in the ED.

During an interview on 09/11/24 at 12:13 PM, Staff G, Chief Nursing Officer (CNO), stated that she expected nursing to observe for expired supplies every month. She agreed expired supplies were found in the ED.

2. Review of the hospital's undated policy titled, "Distribution Inventory Process for Supply Chain Managed Inventory Locations: Systems," showed the Supply Distribution Department maintains the physical aspects of supply locations, bins, and shelving.

Review of the hospital's undated document titled, "Bonne Terre Dayshift Schedule," showed the clean utility room was scheduled for daily cleaning.

Observation on 09/10/24 at 9:18 AM, in the clean utility room, showed the SANE cart with dust accumulation on the top and base of the wheels. The wheels had an accumulation of hair and debris.

Observation on 09/10/24 at 9:15 AM, in the clean utility room, showed dust accumulation in the storage bins.

During an interview on 09/11/24 at 11:10 AM, Staff J, ED Manager, stated that she expected cleanliness in the unit. The Materials Management department staff were responsible for cleaning the bins in the clean utility room. ED staff were responsible for cleaning the equipment.

3. Review of the hospital's undated document titled, "Instruments Event Related Shelf Life," showed an event which may render a sterile (completely clean and free from germs) item suspect of being compromised could be a broken seal. Contamination could occur with dust covered supplies.

Although requested, the hospital did not provide a policy for maintaining the supplies on the emergency OB cart.

Observation on 09/10/24 at 9:25 AM, showed an emergency OB cart with the following unusable items:
- One Stat (immediately) Cesarean section (C-section, surgical delivery of a baby through an incision made in the mother's abdomen and uterus) package with a hole in the outside cover;
- Three surgical clamps in the manufacturer's packaging that had not been sterilized;
- One sterilized forcep (surgical instrument used for delivery of an infant) with a degraded and flaked plastic overwrap;
- Five opened sanitary napkins;
- Seven packages of sutures (a strand or thread used to sew skin and other body tissues together to close up a surgical incision or a tear) with torn edges;
- One torn bag of supplies with sterile gowns, drapes and unwrapped masks;
- One weighted speculum (an instrument used to open the vagina for visual inspection) in the manufacturer's packaging that had not been sterilized;
- One sterile syringe package where the rubber portion of the syringe was hard and discolored;
- Five sterile drape sheets with torn edges; and
- Four inhouse sterilized metal basins with loose wrapping and brittle sterilization tape.

During an interview on 09/10/24 at 9:44 AM, Staff D, ED Assistant Nurse Manager, stated that she agreed the OB items were not useable and did not belong in the ED.

4. Although requested, the hospital did not provide a policy for the cleaning of dry food bins.

Observation on 09/10/24 at 9:00 AM, showed spilled sugar in a dry food bin in the patient's nutrition area.

During an interview on 09/11/24 at 11:10 AM, Staff J, ED Manager, stated that there was no "narrowed down process" for who was responsible for cleaning the dry food bins.

During an interview on 09/11/24 at 12:13 PM, Staff G, CNO, stated that she expected the Dietary staff to keep the dry food bins clean. Spilled products in the dry food bins did not meet her expectations.

5. Review of the undated Center for Disease Control and Prevention Best Practices for Environmental Cleaning in Healthcare Facilities Version Two, showed wall surfaces should be washable.

Observation on 09/10/24 at 9:55 AM, showed paper hanging on the walls at the nurse's station and both medication rooms.

During an interview on 09/11/24 at 11:10 AM, Staff J, ED Manager, stated that she preferred "things" were not hung on the wall and all paper hung in the unit was laminated.

During an interview on 09/11/24 at 12:13 PM, Staff G, CNO, stated that paper hung on the walls in patient care areas should be laminated to provide a cleanable surface. She agreed non-laminated paper hung on the walls posed an infection prevention concern.


48359

Based on observation, interview and policy review, the hospital failed to ensure the safety of suicidal (SI, thoughts of causing one's own death) patients in the psychiatric (relating to mental illness) preferred room when they failed to:
- Remove non-psychiatric safe screws;
- Provide shatter proof light covers; and
- Remove ligature risks.

Findings included:

Review of the hospital's undated policy titled, "Suicide Prevention," showed:
- Patients have the right to be safe in the hospital. Patients who have SI or suicidal behaviors need additional individualized precautions implemented to keep them safe from their own actions.
- Staff caring for patients with an assessed suicide risk level of moderate-high or higher will immediately complete an environment sweep of potentially dangerous items.
- Ligatures are points within the patient's environment that could be used for binding, looping or tying something else to in order to create a sustainable point of attachment that may result in self-harm or loss of life such as a hospital bed side rails and certain door handles.
- Dangerous items include any other items deemed to be dangerous in the proximity of a patient.

Review of the hospital's document titled, "Environmental Assessment Tool," dated 03/20/24, showed the tool was used for patients at risk of harm/injury to self and/or violence to others and directed staff to immediately remove all potential hazards.

Observation on 09/10/24 at 10:25 AM, in the psychiatric preferred room in the Emergency Department (ED), showed a phone jack cover and door window lock panel with non-psychiatric safe screws.

Observation on 09/11/24 at 8:45 AM, in the psychiatric preferred room, showed two commercial door handles with a rigid level design that were patient accessible and posed a ligature risk. A hospital bed with multiple possible ligature risks on the bed frame, including the side rails. Two ceiling lights with fluorescent light tubes, the light covers consisted of a brittle type of plastic that allowed patients access to the glass from the fluorescent light tubes.

During an interview on 09/12/24 at 12:13 PM, Staff G, Chief Nursing Officer (CNO), stated that the presence of non-psychiatric safe screws, non-shatter proof light covers, and a non-psychiatric safe door handle did not meet her expectations of a psychiatric preferred room. She stated she recognized the hospital bed, stretcher and door handle as a ligature risk.

During an interview on 09/11/24 at 11:10 AM, Staff J, ED Manager, stated that she "assumed" staff removed the hospital bed and placed a stretcher in the psychiatric preferred room for suicidal patients.

During an interview on 09/11/24 at 11:25 AM, Staff A, Registered Nurse (RN), stated that the hospital bed typically stayed in the psychiatric preferred room with the suicidal patient. An ED stretcher could be used, the stretcher did have two side rails. The bed or stretcher may be removed, and the mattress laid on the floor at the nurse's discretion for the patient's risk of self-harm.

Based on observation, interview and policy review, the hospital failed to complete the inventory checklist on the adult and pediatric (pertaining to children) crash carts (mobile cart which contains emergency medical supplies and medication) and the procedure cart in the Emergency Department (ED).

Findings included:

Review of the hospital's undated policy titled, "Crash Cart," showed the nursing staff, in patient care areas, assumes responsibility for maintaining daily check lists, equipment on cart and patency of locks. Crash carts are checked daily by using crash cart log/daily checklist to verify the oxygen tank is present on the crash cart with greater than 1,000 pounds per square inch (psi); number seal/lock is intact; lock number on the cart matches the last number entered on the crash cart checklist; if separate airway box/bag is used, numbered seal/red lock is intact; defibrillator is functioning properly, plugged in, battery charge indicator light is on and hands free defibrillator pads are present; electrocardiogram (ECG, test that records the electrical signal from the heart to check for different heart conditions) paper is present; packs of electrodes are on the crash cart; appropriate size AMBU bag (a hand held device used to provide positive pressure ventilation to patients who are not breathing or not breathing adequately) and face mask are present; suction machine, if present, is plugged in and functional; crash cart label/check list is complete; stock items expiring within three months are replaced and date/initial checklist when check is complete/accurate.

Review of the hospital's undated document titled, "Parkland Health Center Adult Code Cart Inventory List," showed on 01/01/24 through 09/10/24, the adult crash cart was checked 05/01/24, 05/09/24, 05/22/24, 05/30/24, 06/02/24, 07/01/24 and 09/09/24.

Review of the hospital's undated document titled, "Parkland Health Center Pediatric Crash Cart Inventory," showed on 01/01/24 through 09/10/24, the Pediatric crash cart was checked 01/16/24, 02/18/24, 03/21/24, 04/21/24, 07/07/24 and 08/09/24.

Review of the hospital's document titled, "ED Bonne Terre Procedure Cart Inventory," showed on 01/01/24 through 09/10/24, the cart was checked 05/2024, 06/2024 and 09/2024.

During an interview on 09/12/24 at 12:13 PM, Staff G, Chief Nursing Officer (CNO), stated that she expected the crash carts and procedure carts inventory to be completed monthly and each time a cart was used. The missing inventory checks did not meet her expectations.

During an interview on 09/11/24 at 11:10 AM, Staff J, ED Manager, stated that she expected the crash carts and procedure carts inventory to be up to date and completed on a monthly basis.

During an interview on 09/10/24 at 9:44 AM, Staff D, ED Assistant Nurse Manager, stated that she agreed the crash carts and procedure carts inventory lists were incomplete and had missing dates.