HospitalInspections.org

Based on interview, record review, and document review, the facility failed to ensure a patient was provided with the consent to treat and had been explained the conditions of admission after the physician discontinued the Legal 2000 for 1 of 30 sampled patients (Patient #21).

Findings include:

Patient #21 (P21)

P21 was admitted to the facility on 08/29/18 with chief complaint of suicidal ideation and chest pain.

P21 was admitted under a Legal 2000 (the State of Nevada Legal Process for Involuntary Admission of a patient who presents a danger to self or others). On 08/31/18, P21's Legal 2000 was discontinued. P21 was discharged from the facility to home on 09/04/18.

There was no documented evidence P21 was afforded the right to be informed of the health status, ability to become involved in care planning and treatment, and the right to refuse treatment after discontinuation of the involuntary hospitalization from 08/31/18 through the date of discharge on 09/04/18.

On 09/06/18 at 9:45 AM, the Admissions Clerk verified there was no dated consent and Conditions of Admission signed by P21 after the patient's Legal 2000 was discontinued. The Admissions Clerk indicated the clinical staff was responsible to ensure the patient was informed of his right to be informed about the care and treatment.

On 09/06/18 at 9:00 AM, the Health Information Management Manager indicated the Conditions of Admission documented consent to treatment should be completed upon admission to the facility. If a patient was not able to consent due to a Legal 2000, then after the discontinuation of the Legal 2000 the patient should be explained the right to consent to treatment. The patient's signature and the date should be documented on the Conditions of Admission and consent forms.

The Patient Brochure indicated the patient has the right to be informed about the medical care and services, and the right to refuse the care.

The Patient's Bill of Rights, indicated a patient has a right to receive information to make an informed decision about the healthcare.

The facility's policy, Medical Record Content Policy dated 02/27/18, indicated evidence of informed consent shall be maintained in the patient's medical record.

Based on interview, record review, and document review, the facility failed to ensure the medical record was accurate for 1 of 30 sampled patients (Patient #13).

Findings include:

Patient #13 (P13)

P13, a male patient, was admitted on 08/31/18, with diagnoses including malignant hypertension and hemiplegia.

On 09/02/18, the patient's consulting Physician (Physician #1) documented the patient's genitourinary system was negative for vaginal discharge.

On 09/04/18, the patient's attending Physician (Physician #2) documented the patient's genitourinary system was negative for vaginal discharge.

On 09/04/18, the facility's Chief Nursing Officer indicated it was inappropriate to document the presence of absence of vaginal discharge for a male patient.

The facility's policy titled Medical Record Content Policy, dated 02/27/18 indicated the medical record must be accurately documented.

Based on a review of the established policy, radiology records, and an interview, the facility failed to follow the approved policy for monitoring the exposure of radiation workers.

Findings include:

The policy entitled "Radiation Monitoring Badge" stated that "The Radiation Safety Officer shall review the records monthly." A review of the dosimetry records revealed that the reports were generated and reviewed quarterly. The interview with the personnel conducted on 09/05/18 confirmed that the review of the reports occurred quarterly.

Based on observation, interview, and document review, the facility failed to ensure raw and leftover cooked meats were covered.

Findings include:

On 09/07/18 at 10:15 AM, there was raw chicken stored in the reach-in refrigerator. The raw chicken was left uncovered.

On 09/07/18 at 10:15 AM, there was a beef roast stored in the walk in refrigerator. The beef roast was not covered.

On 09/07/18 at 10:20 AM, the Director of Dietary indicated raw meats should always be covered. The Director of Dietary indicated the roast beef had been used for the dinner the previous night and stored uncovered in the walk-in refrigerator.

The facility's policy, Storage and Use of Leftovers, dated 02/27/18, indicated all leftover food items shall be handled and stored to prevent contamination. All leftover cold food for storage in the refrigerator shall be placed in storage containers and completely covered with plastic or foil wrap.

Based on observation, interview, record review and policy review, the facility failed to ensure a patient was not given food items the patient was allergic to for 1 of 30 sampled patients (Patient #20).

Findings include:

Patient #20 (P20)

P20 was admitted to the facility on 08/30/18, with diagnoses including respiratory failure and dysphagia. On admission, the patient's allergy was documented to be "milk-related compounds".

On 09/01/18, the Physician from the contracted Hospice for General Inpatient Care (GIP) documented the patient reported thirst. Nectar thick liquids and a pureed diet were ordered. The Physician documented the patient was given sips of "nectar thick dairy beverage" which was tolerated except for one episode of choking, which was cleared easily.

On 09/07/18 at 1:00 PM, the facility's Registered Dietitian indicated the Dietary Department had a record of the patient's allergy. The Electronic Medical Record (Med-Host) interfaced with the computer based dietary software (Meal-Tracker). The Dietitian stated it could not be determined exactly which beverage was thickened, but a patient allergic to "milk-based compounds" should not be given milk products.

The facility's policy titled Nutritional Services Guidelines, dated 02/27/18 indicated diet orders should include dietary modifications including allergies to food.

Based on interview and document review, the facility failed to ensure at least two members of the Utilization Review Committee were either a Doctor of Medicine or Osteopathy.

Findings include:

Review of the Utilization Management Committee minutes dated on April 24, 2018 and July 24, 2018, lacked documented evidence at least 2 physicians were part of the committee.

The sign in sheet for the committee meeting dated on April 24, 2018, revealed there was no documented evidence either a Medical Doctor (MD) or Doctor of Osteopathy (DO) was present at the meeting. The sign-in sheet for the Utilization Committee Meeting dated on July 24, 2018, revealed only one DO was in attendance.

The Chief Nursing Officer confirmed there was no documented evidence at least 2 doctors were a part of the Utilization Management Committee on a consistent basis.

Based on interview, record review, and document review, the facility failed to ensure isolation precautions were put into place timely for patients with suspected Clostridium difficile (C-dif) for 3 of 30 sampled patients (Patient #24, #28 and #29).

Findings include:

Patient #24 (P24)

P24 was admitted to the facility on 08/26/18 with a diagnoses including dyspnea.

The Nurse's Note dated 09/01/18 documented P24 had loose stools.

The Physician's Note dated 09/01/18, indicated P24 complained of diarrhea, and ordered stools samples for C-dif.

There was no documented evidence isolation precautions were put into place on 09/01/18 upon suspicion of C-dif. The C-dif isolation precautions were not documented as put into place until 09/02/18.

On 09/07/18 at 9:30 AM, the Infection Control Coordinator verified there were no C-dif isolation precautions put into place until 09/02/18.

Patient #28 (P28)

P28 was admitted to the facility on 08/03/18, with diagnoses including respiratory failure and metabolic encephalopathy. P28 was discharged from the facility on 08/22/18.

The Physician's Orders dated 08/18/18 at 8:35 PM, indicated C-dif stool sample. There was no documented evidence C-dif isolation precautions were put into place until 08/20/18.

On 09/07/18 at 9:30 AM, the Infection Control Coordinator indicated on 08/18/18 C-dif was suspected, but there were no C-dif isolation precautions put into place until 08/20/18.

Patient #29 (P29)

P29 was admitted to the facility on 08/03/18, with diagnoses including gastroenteritis and colitis.

On 08/03/18, the physician ordered a stool sample for C-dif. The results on 08/05/18 indicated the C-dif toxin was positive. There was no documented evidence the C-dif isolation precautions were put into place until 08/05/18.

On 09/07/18 at 9:30 AM, the Infection Control Coordinator verified the patient was suspected for C-dif on 08/03/18, but there were no C-dif isolation precautions put into place until 08/05/18.

On 09/07/18 at 9:30 AM, the Infection Control Coordinator indicated it was the policy of the facility that, upon suspicion a patient had C-dif, isolation precautions would be put into place.

On 09/08/18 at 9:00 AM, the Chief Nursing Officer indicated isolation precautions were to be put into place as soon as there was a suspicion of C-dif, and documented in the chart accordingly.

The facility's policy Clostridium Difficile (undated) indicated contact precautions shall be used for patients with known or suspected C-difficile associated disease. Precautions shall be continued until diarrhea ceases.

Based on interview and record review, the facility failed to ensure consistent documentation for discharge planning was in the medical record from the time the patient was admitted to final discharge for 3 of 30 sampled patient records.

Findings include:

During the survey process, 30 patient records were reviewed for discharge planning. The electronic record of the facility had a specific area where discharge planning was to be documented. There was no consistent documentation in the records for staff to view the patients' discharge planning process.

On 9/6/18 in the afternoon, the Case Manager indicated the discharge plan was scattered throughout the patient records and not in one place where an ongoing plan could be visible to all staff.

On 9/7/18 the Chief Nursing Officer confirmed it was hard to find the discharge planning of the patients' in the medical record and they were working to improve the process.

The discharge planning section in the electronic record of all 30 of the patient files reviewed were left blank and no documented evidence the section was being used.

On 9/6/18 in the afternoon, the Case Manager indicated the discharge planning section in the electronic record should have been utilized so other staff were aware of the discharge plan of the patient and the plan could have been discussed with the patient throughout the stay.

The Case Manager was unable to locate discharge planning information in the electronic medical record for 3 patient electronic records.