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Based on observation, document review, and staff interviews, the facility failed to provide a dosimeter badge (radiation detecting device) to all staff exposed to radiation in the operating room during surgical procedures utilizing 2 of 2 portable x-ray machines in the operating room (OR). The facility reported 30 orthopaedic and 8 urology portable x-ray procedures performed in the operating room every month.

Failure to provide dosimeter badges could potentially result in staff's exposure to unintentional and unknown amounts of ionizing radiation.

Findings include:

1. Observation, during tour of the OR, on 5/14/13 at 9:50 AM, showed the facility had 2 portable x-ray machines. Staff completed a procedure in OR #1 utilizing 1 of 2 portable x-ray machines. Staff used lead aprons during the procedure and remained in the room during the procedure. Staff failed to wear dosimeter badges during the procedure.

2. Review of policy/procedure titled "Radiation Safety", revised 2/2012, revealed, in part, "Employee Safety: No employee shall be allowed to receive exposure in excess of 1250 millirem per calendar quarter. In the event of radiation or an excessive exposure, the Iowa Department of Public Health should be notified. . . ."

3. During an interview on 5/14/13 at 9:50 AM, Staff A, Director of Surgical Services stated the operating room staff, including physician, anesthesia and nursing staff do not wear dosimeter badges in the OR during procedures when the portable x-ray machines are used.

4. During an interview on 5/14/13 at 11:00 AM, Staff B, Director of Radiology stated the radiology technicians perform the portable x-ray procedures in the OR. All staff wear shielding devices during the procedures. OR staff are not required to wear dosimeter badges during the procedures. The facility tested radiation levels a year ago in the OR and determined OR staff did not need to utilize the dosimeter badges due to low levels of radiation.

Based on review of the facility diet manual and staff interviews, the hospital failed to ensure the approved diet manual was a current edition.

The dietary manager reported dietary staff provided approximately 80-90 patient meals per day.

Failure to ensure the facility utilized a current diet manual could potentially result in therapeutic diets served to patients which do not meet current national standards for all diet types.

Findings include:

1. During an interview on 5/13/13, at 11:30 AM, the Dietary Manager reported the facility diet manual was the Simplified Diet Manual, 10th edition which was used as a reference by the dietary staff for therapeutic diet questions and by the clinical dietitian for planning patient menus.

During an interview on 5/13/13 at 1:45 PM, the clinical dietitian confirmed the facility diet manual was the Simplified Diet Manual, 10th edition, with a copy located in the kitchen and patient care areas (emergency, obstetrics and medical/surgical units). The clinical dietitian reported she was not aware the manual was more than five years old, with the most current 11th edition released in 2012.

2. Review of the Simplified Diet Manual, 10th edition showed the manual was published in 2007.