HospitalInspections.org

Based on record review and interview the hospital did not have a matrix determining they types and numbers of nursing personnel and staff necessary to provide nursing care for all areas of the hospital.

Findings included:

The Nurse Staffing Grids were available and reviewed from 10/09/2020 through 11/19/2020.
The 10/09/2020 day shift nurse staffing grid reflected Personnel #11 was assigned four patients in the ICU and Personnel #12 was assigned seven patients on the second floor Covid-19 unit.
The 10/14/2020 night shift nurse staffing grid reflected Personnel #13 was assigned four patients in the ICU.
The 10/16/2020 night shift nurse staffing grid reflected Personnel #14 was assigned four patients in the ICU.
The 10/17/2020 day shift nurse staffing grid reflected Personnel #15 was assigned four patients in the ICU and Personnel #14 was assigned four patients in the ICU on the night shift.
The 10/23/2020 night shift nurse staffing grid reflected Personnel #16 was assigned four patients in the ICU.
The 10/24/2020 day shift nurse staffing grid reflected Personnel #17 was assigned seven patients on the second floor Covid-19 unit. The 10/25/2020 night shift nurse staffing grid reflected Personnel #18 was assigned four patients in the ICU.
The 10/26/2020 day shift nurse staffing grid reflected Personnel #19 was assigned four patients in the ICU and Personnel #20 was assigned four patients in the ICU on the night shift.
The 10/30/2020 day shift nurse staffing grid reflected Personnel #19 was assigned four patients in the ICU.
The 10/31/2020 night shift nurse staffing grid reflected Personnel #21 was assigned four patients in the ICU.
The 11/04/2020 night shift nurse staffing grid reflected Personnel #22 was assigned four patients in the ICU.
The 11/10/2020 day shift nurse staffing grid reflected Personnel #7 was assigned four patients in the ICU.

The staffing grids did not denote any of the patients as being stepdown patients.
The request for the staffing grids for each unit of the hospital were requested and none were received.

During an interview on 11/23/2020 at 0940 Personnell #1 stated the nurse to patient ratio was 6:1 on the medical surgical unit and 3:1 in the Intensive care unit (ICU). Personnel #1 stated if the hospital did not have the nursing staff to keep the nurse to patient ratio they would not admit any new patients. Personnel #1 stated sometimes an ICU nurse would carry a 4:1 patient load, but the fourth patient was a stepdown patient.

During an interview on 11/23/2020 at 1215 Personnel #6 stated they had carried a 7:1 patient ratio on the second floor with only a patient care tech for help. Personnel #6 stated all of the patients were total care patients and four of the patients were feeders.

During an interview on 11/23/2020 at 1230 Personnel #7 stated the ICU nurses sometimes had to carry a 4:1 patient ratio. Sometimes the fourth patient would be a stepdown patient but not always. Personnel #7 stated they did not feel the current staffing ratio was safe.

Based on interview the hospital failed to employ methods of preventing and controlling the transmission of infections within the hospital in that multiple staff interviewed stated they had to reuse tube feeding bags and tubing beyond the manufacturer's recommended use.

Findings included:

During an interview on 11/23/2020 at 1215 Personnel #6 stated the hospital had a problem of obtaining the tube for the tube feeding pumps and the nurses were having to reuse the tubing.

During an interview on 11/23/2020 at 1230 Personnel #7 stated the house supervisors had told the nursing staff to use the tube feeding tubing for two days instead of one day.

During and inter view on 11/23/2020 at 1240 Personnel #8 stated the hospital had a shortage of tube feeding pump tubing and the patients had been changed to bolus feedings. Personnel #8 stated when the tubing was available again the staff was told to use the tubing for two days instead of one day.

During an interview on 11/23/2020 at 1250 Personnel#9 stated when the tube feeding came back in stock the staff were instructed to use the tube feeding tubing for two days. Personnel#9 stated they believed that was what the packaging stated was the length of use for the tubing.

The Gastric Tube Feeding Policy dated 06/2016 reflected ..."K. Nursing Management Implication ...7. Change enteral feeding bag and tubing every 24 hours ..."
The package inserts for the Kangaroo Epump EN Plus Spike with Flush bag reflected ...Do not use greater than 24 hours ..."