HospitalInspections.org

Based on record review, observation and interview on 04/16/2019, nursing failed to supervise and evaluate the care of sampled patients. The RN failed to ensure implementation of physician orders related to telemetry monitoring for 3 of 20 sampled patients. Facility had a current census of 20 patients.

Record review of the facility policy "Cardiac (ECG) Monitoring Policy" dated 10/25/2017 stated:
Certified Personal that can Monitor:
RN nursing with ACLS (advance cardiac life support) certification
LVN with ACLS certification
Respiratory therapist with ACLS certification
ECG certified personal
Purpose: Communicates ...a change from the patient's baseline occurs, potential life threatening arrhythmias occur, non-life threatening rhythms/rates occur that are a significant change from the previous monitoring trends.

Record review on 04/16/2019 at 0930 the nursing assignment sheet, revealed three patients (ID #4, 13, 14) were assigned to telemetry per doctors orders.

Record review on 04/17/2019 at 1400 revealed the doctors order written by the physician (ID #54) discontinued telemetry for the following patients, (ID #4, 13, 14).

Observation on 04/16/2019 from 0930-1115 revealed the telemetry at the nurse's station was frequently not monitored between 0930-1100. The two (2) respiratory therapist (RT) (ID #60, 64) were noted to be in two different patients room between 0930-0950. The telemetry monitor was left unattended.

Observation of the RT (ID #64) at 1115 on 04/16/2019, was observed watching another computer.

Interview on 04/18/2019 at 1200 with the Medical Director (ID #54), who stated; we have monitor techs they mostly work at night to watch the monitor. He also he stated he discontinued the telemetry on 04/17/2019 at 1400 for patient (ID #4), (ID #13) ID #14) because on was patient was going home, one was a DNR, (do not resuscitate) and the other didn't need it.

Interview on 04/16/2019 at 1045 with the CNO, RN (ID #51) stated, "when respiratory therapy is here, they watch the monitor."

Interview on 04/17/2019 at 0900 with respiratory therapist (ID #60) who stated I watch the monitor and can't leave until someone comes to relieve me.

Based on observation, interview and record review, the facilities failed to ensure direct care staff (ID #54, 55, 60, 64, 67, and 72) maintained the principles and practices for preventing transmission of infectious agents within the hospital. This failed practice had the potential for the spread of infection to all patients on census.

The findings included:

Citing five (5) random observations leaving rooms, 311, 312, 313, and 315.

Record review of facility policy dated 07/12/2017 "Hand Hygiene Policy" stated, Hands must be must be disinfected by using soap and water or alcohol based hand sanitizers if hands are not visibly soiled: before and after patient contact.

Observation on 04/16/2019 at 0955 and 1208, Certified Nurse Assistant (CNA) (ID #55), was observed entering and leaving rooms 311 (ID #4) and 315 (ID #15) without sanitizing hands.

Observation on 04/16/2019 at 1015, Respiratory Therapist (ID #60), was observed entering and leaving room 311 (ID #4) without sanitizing hands.

Observation on 04/16/2019 at 1155, Medical Doctor (ID #54), was observed entering and leaving room 311 (ID #4) without sanitizing hands.

Observation on 04/16/2019 at 1205, Nurse Practitioner (ID #67), was observed entering and leaving room 312 (ID #16) without sanitizing hands.

Observation on 04/16/2019 at 1210, Physical Therapy (ID #72), was observed entering and leaving room 313 (ID #17) without sanitizing hands.

Interview on 04/17/2019 at 1100 with the CN0 (ID #51), she stated the "infection control nurse is new to her role but we are monitoring hand hygiene."

Record Review of Association of Peri-Operative Registered Nurses (AORN) recommended practices for cleaning, handling, and processing of anesthesia equipment, updated January 28, 2013, read :"Laryngoscope blades should be processed according to manufacturers' instructions by either high-level disinfection or sterilization and protected from contamination until used. Processed blades should be stored in packages, appropriate for the processing method selected, to ensure the blade is protected from contamination. The storage of unpackaged laryngoscope blades is unreliable and leads to questions regarding the safe use of the blades."

During an Observation and inspection on 04/16/2019 at 0945 of the crash cart on the 3rd floor nursing unit had unwrapped laryngoscope and two blades lying in the bottom of the intubation tackle box.

Interview 04/16/2019 at 0945 with the Director of Respiratory Therapy (ID # 64)
stated "yes, they need to be wrapped".