HospitalInspections.org

Based on document review and staff interview, the nursing director failed to ensure the nursing staff followed physician orders for 4 of 5 patients. (patients #1, 2, 3, and 5)

Findings include:

1. Review of patient #1 medical record indicated the following:
(A) He/she was admitted to the medical/surgical floor on 4/1/13.
(B) An order was written on 4/1/13 for accucheck to check blood sugar level bid (twice daily).
(C) The record lacked documentation that the accucheck was completed bid per order. The accucheck was only completed once on 4/2/13.

2. Review of patient #2 medical record indicated the following:
(A) He/she was admitted to the medical/surgical floor on 3/31/13.
(B) An order was written on 3/31/13 for accucheck to check blood sugar level every a.m. and p.m.
(C) The record lacked documentation that the accucheck was completed in the evening on 4/2/13.

3. Review of patient #3 medical record indicated the following:
(A) He/she was admitted to the behavioral health unit (BHU) on 3/29/13.
(B) An order was written at 1615 on 3/29/13 to take vital signs twice daily.
(C) The patient's blood pressure was taken only once on 4/1/13 and 4/2/13. The medical record lacked documentation of why the blood pressure was not taken per order.

4. Review of patient #5 medical record indicated the following:
(A) He/she was admitted to the BHU on 3/29/13.
(B) An order was written at 0700 on 3/29/13 to take vital signs twice daily.
(C) The patient's blood pressure was taken only once on 4/2/13 and was not taken in a.m. of 4/3/13. The medical record lacked documentation of why the blood pressure was not taken per order.

5. Staff member #12 indicated the following in interview beginning at 12:25 p.m. on 4/3/13:
(A) Vital signs are taken twice daily or each 12 hour shift on the BHU.
(B) He/she verified the medical record information for patients #1, 2, 3, and 5 at 5:30 p.m. on 4/3/13.

Based on observation and interview, the facility failed to store medications in a safe and secure manner to ensure the safety of patients, visitors, and others.

Findings included:

1. While touring the Ambulatory Care Unit, room 205, on 4-3-13 at 1200 hours with staff members #1 and #2, a 10ml vial of Succinylocholine 20mg/ml, 10ml vial, was observed unsecured on top of a medication/anesthesia cart in an unlocked, unsecured, unstaffed unit of the hospital; next to the vial on top of the medication/anesthesia cart were twelve 18 gauge needles and nine 10ml syringes.
2. Interviews were conducted with staff members #1 and #2 at 1200 hours, in room 205, who confirmed a 10ml vial of Succinylocholine 20mg/ml, 10ml vial, was unsecured on top of a medication/anesthesia cart in an unlocked, unsecured, unstaffed unit of the hospital and next to the vial on top of the medication/anesthesia cart were twelve 18 gauge needles and nine 10ml syringes.

Based on observation and interview, the facility failed to detect and remove outdated medications from 2 of 2 medication carts used for patient medication administration.

Findings included:

1. While touring the facility on 4-3-13 at 1200 hours with staff members #1 and #2, the following outdated medications were observed in the medication/anesthesia cart in Room 205:
a.) Three - Epinephrine 1:1000; 1ml; expiration 4-1-13
b.) Two - Etomidate 40mg/20ml; 20 ml vial; expiration 3-2013
c.) One - Naloxone .4mg/ml; 10ml vial; expiration 4-1-13
d.) Three - Adenosine 6mg/2ml; 2ml vial; expiration 3-2013
e.) One - Metoclopramide 10mg/2ml; 2ml vial; expiration 10-1-12
f.) One - Epinephrine 50mg/ml; 1 ml; expiration 3-2013
g.) One - Phenylephrine HCl 10mg/ml; 10ml vial; expiration 12-2012
h.) Ten - Vecuronium 10mg/10ml; 10ml vials; expiration 3-2013
i.) One - Bupivacaine .5%; 5mg/ml; 50 ml vial; expiration 1-1-13
j.) Seven - Neostigmine Methylsulfate 1:1000; 1mg/ml; 10ml vial; expiration 3-2013
2. While touring the facility at 1240 hours with staff members #1 and #2, the following outdated medications were observed in the endoscopy medication cart in the endoscopy room:
a.) Four - Naloxone HCl .4mg/ml; 1ml vial; expiration 2-1-13
b.) Nineteen - Promethazine 25mg/ml; 1ml vials; expiration 3-2013
c.) One - Lidocaine HCl Jelly 2%; 10ml container; expiration 3-2013
d.) Six - Lidocaine HCl 40mg/ml 4%; 5ml vial; expiration 4-1-13
e.) One - Flumazenil 1mg/10ml; 10ml vial; expiration 12-2012
f.) One - GlucaGen 1mg/1ml; 1ml vial; expiration 1-2013
2. Interviews were conducted with staff members #1 and #2 at 1200 hours and 1240 hours, in Room 205 and the endoscopy room respectively, who confirmed the outdated medications observed in the medication carts.

Based on observation and interview, the facility failed to maintain the building, including fixtures and ceilings, in an orderly and well-kept/maintained manner to ensure the safety and well-being of patients, visitors, and staff.

Findings included:

1. While touring the facility on 4-3-13, beginning at 1110 hours with Staff #1 and #2, the following was observed:
a.) Room 247 was observed to have 4 stained ceiling tiles.
b.) Room 246 was observed to have 2 stained ceiling tiles.
c.) Room 201 was observed to have 4 stained ceiling tiles and the bathroom ceiling tile was dislodged that contained the exhaust vent.
d.) Room 212 was observed to have 1 stained ceiling tile.
e.) Room 211 was observed to have 1 stained ceiling tile.
f.) Room 205 was observed to have 1 stained ceiling tile and stains surrounding the ceiling heat vent.
g.) Room 220 was observed to have 3 missing ceiling tiles
h.) Room 221 was observed to have 3 missing ceiling tiles
i.) Room 223 was observed to have 1 missing ceiling tile, 1 stained ceiling tile, the bathroom toilet was heavily stained and contained a cigarette butt, and the shower head was missing.
j.) The hallway outside room 227 was observed to have a ceiling tile heavily stained bulging ceiling tile and one stained ceiling tile.
k.) The hallway just inside the behavioral health unit was observed to have 1 stained ceiling tile.
l.) Room 307 was observed to have 4 stained ceiling tiles.
m.) Room 308 was observed to have stained ceiling drywall.
n.) Room 311 was observed to have 4 stained ceiling tiles.
o.) Room 313 was observed to have 3 stained ceiling tiles.
p.) Room 315 was observed to have 1 stained ceiling tile.
q.) Room 317 was observed to have a non-working light over the sink and a ceiling light that was dim and not working properly.
r.) The hallway outside the Human Resources Department was observed to have 4 stained ceiling tiles.
s.) The hallway outside the Housekeeping Department was observed to have 2 stained ceiling tiles.
t.) The Clean Linen Storage Room was observed to have 2 stained ceiling tiles above the clean linens.
u.) The hallway outside the Pharmacy was observed to have 2 stained ceiling tiles.
v.) The Pharmacy was observed to have a stained ceiling tile above the area where medications are stored.
2. An interview was conducted with staff member#1, who was present on the facility tour, on 4-3-13 at 1640 hours. He/she confirmed the findings in the physical plant tour of stained ceiling tiles/ceilings during the hospital tour, the stains in the toilet in the bathroom of 223 (containing a cigarette butt and no water) and missing shower head, and lights that did not work properly in room 317.
3. An interview was conducted with staff member #2, who was present on the facility tour, on 4-3-13 at 1700 hours. He/she confirmed the findings in the physical plant tour of stained ceiling tiles/ceilings during the hospital tour, the stains in the toilet in the bathroom of 223 (containing a cigarette butt and no water) and missing shower head, and lights that did not work properly in room 317.