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Based on record review and interview the facility's Governing Body failed to enforce it own Policy and Procedure related to reassessment of patients after a change in patient's condition in 1 out of 10 medical records reviewed. (Patient ID #1). Facility has a current census of 41 patients.

Findings:

Policy Review:

Review of the facility"s current policy entitled "Assessment/Re-Assessment - Interdisciplinary Patient, " Policy # H-PC 02001, last release date 03/2019. Purpose: This procedure establishes guidelines to assure: 1. Care provided to each patient is based on an assessment of the patient's relevant physical, psychological and social needs. Policy: 1. All patients will have an initial assessment and appropriate follow up assessments based upon patient specific identified needs including physical, psychological and social-cultural status. ii. (g) Patient assessment is based on but not limited to the following: i. To evaluate patient response to care, treatment and services. II. To respond to a significant change in status and/or diagnosis or condition.

Review of the medical records for Patient ID #1 along with the Nurse Manager, Employee ID #2 on 4/23/2019 at 3:00 p.m. documents on 02/28/2019 the patient's blood pressure documented at 12:32 p.m. as 176/76. The next blood pressure documented at 2:55 p.m. as 101/49. Records document Registered Nurse Employee ID # H received a telephone order from physician ID N for an intravenous one time infusion of sodium chloride 0.9% (Normal Saline) 500 ml., rate wide open. There was no documentation of a reassessment by nursing staff for the change in patient's blood pressure or response to medical treatment after the 500 ml bolus of normal saline.

Interview on 04/23/2019 at 3:30 p.m. with the facility's Nurse Manager Employee ID #2 confirmed that registered nurse ID #H should have completed a reassessment on Patient ID #1 after the drop in the patient's blood pressure and after the normal saline bolus.

Based on observation and interview the facility failed to ensure that patients received care in a safe setting. The facility failed to maintain patient equipment and emergency carts which could potentially result in the spread of infection and communicable diseases among patients and staff.

These infection control issues were observed in 4 of 10 patient care rooms (Rooms#s 400,406, 407 and 419) and 3 of 3 emergency crash carts observed ( 4th floor, 3rd floor and Intensive Care Unit). The hospital has a current census of 41 patients.

Finding include:

Policy Review:

Review of the facility's current policy titled "Cleaning of Shared Patient Medical Equipment", Policy ID # H-IC-02-0285, Release date 06/2018 reads: Purpose This policy established guidelines to assure the shared patient medical equipment has been cleaned and disinfected prior to use on other patients so that transmission of infections is minimized. All shared patient care equipment is cleaned after each patient use according to manufacturer's instructions for use. All equipment will be disinfected with bleach disinfectant after use on a patient with clostridium difficile (Cdiff), unless contraindicated based on the facility's Annual Infection Risk Assessment. Policy: The policy of Kindred hospitals is to ensure the following: 1. An Environmental Protection Agency registered disinfectant that has been approved by the infection Prevention and Control Committee shall be used for cleaning.... 2. All equipment shall be cleaned and disinfected with a low level disinfectant. 3. Insure that equipment is cleaned, disinfected using the appropriate contact time...


Observation of the patient care areas on 04/22/2019 at 12:30 p.m. along with facility Nurse Manager Employee ID # 2 it was observed emergency crash cart located on the 3rd, 4th and the Intensive Care Unit had white plastic trays located on the top of each cart with emergency equipment stored on top of the white trays. The plastic trays were observed to have multiple cracks and breaks along with missing edge pieces of plastic. Also observed was a sticky residue on the surface and edges what appeared to be be tape residue. APIC (Association of Professionals in Infection Control) recommends tape residue be removed from surfaces as hard surfaces can not be sanitized when tape residue is present. When the surface is broken or rusty the surface can no longer be sanitized completely.

Observation on 04/22/2019 1:00 p.m. of patient care rooms along with facility Nurse Manager Employee ID #2 identified the following:

04/22/2019 tour of the 4th floor patient care rooms along with with facility Nurse Manager Employee ID #2 the following items were observed:

Room 400 - unoccupied vacant room with one IV pole with visible surface rust on each wheel canister and also on the circular cover above the wheel base.

Room 406 - unoccupied vacant room with one IV pole with visible surface rust on each wheel canister and also on the circular cover above the wheel base.

Room 407 - occupied vacant room with one IV pole with visible surface rust on each wheel canister .

Room 419 - unoccupied vacant room with one IV pole with visible surface rust on each wheel canister and also on the circular cover above the wheel base.

Interview with the facility Nurse Manager Employee ID #2 on 04/23/2019 at 10:30 a.m. confirmed the rust on the medical equipment is not acceptable and agreed that the equipment could not be properly disinfected with surface rust. Employee ID #2 also confirmed the broken and plastic trays on top of the emergency crash cart should be replaced and could not be properly disinfected.