HospitalInspections.org

Based on observation, interview, and record review the facility failed to implement it's restraint policy/procedure to ensure staff obtain orders for patients who were on restraint; and
Failed to provide documentation the patients were evaluated while on restraint. This failed practice had the potential to increase the risk for patient falls. Citing 3 of 4 patients(1,2,and 3)on restraints on the Medical/Surgical Unit.
Findings:
Observation on 8/5/2013 at 11:15 am on the Medical/Surgical Unit revealed Patient #s 1,2, and 3 were in their beds with the four bed rails of the beds in the up position. To get out of bed independently would put the patients at risk of fall and possible injury.
During an interview on 8/5/2013 at 11:45 am with Staff (A) Chief Nursing Officer (CNO) he verified the patients were not able to get out of their beds independently. He stated of the four patients observed with the bedside rails up only one patient of those patients should have been on restraint.
During an interview on 8/6/2013 at 10:35 am with Staff (B) the facility's Director of Quality, she stated the practice of putting the four side rails up while patients were in bed was identified as a problem and an in-service was conducted. She stated monthly follow up observations were conducted.
Review of orders orders for the three (3) patients revealed no orders written for restraints.
Review of nursing documentation for the patients revealed no indication for restraints and no documentation the patient ' s were evaluated while in restraints.
Review of the facility's Restraint policy/procedure revised 5/22/2013 documented:
"The use of restraint must be in accordance with the order of a physician or other Licensed Independent Practitioner (LIP) who is responsible for the care of the patient and authorize to order restraint by the facility policy and in accordance with state law.
The physician's order must specify the clinical justification for the restraint.
The use of restraints shell result in a written modification of the patient's Care Plan.
The use of restraints will be frequently evaluated and discontinued at the earliest possible time based on the assessment and re-evaluation of the patient's condition."

Based on observation, interview, and record review, the facility failed to supervise the nursing care of patients to ensure their hygiene needs were met in a timely manner;
Failed to evaluate the need for Foley Catheter,Normal saline and restraint use according to the facility's policy and procedure. This failed practice had the potential to adversely affect patients admitted to the facility. Citing four (4) of seven (7) random observations on the Medical/Surgical Unit Patient (#s1,4,3 and 5)

Findings:
Observation on 8/5/2013 between the hours of 10:35 am and 12:30pm on the Medical Surgical Unit at the facility revealed the following information:
Patient # 1
Patient (#1) was lying in bed room foul odor Aide went in room stated she was just going to change the patient. Observation revealed the patient had been lying in dried feces. The patient stated she was given breakfast and was not offered a bath or water to wash her face and brush her teeth. Further observation revealed Patient (#1) had a Foley catheter with 1000 cc of urine, the Foley bag was touching the floor.
Review of the physician orders revealed no orders or indication for the Foley catheter use. There was documentation the patient was incontinent of stool. Review of Nurses notes and care plans revealed no documentation that the patient was evaluated for the continued use of a Foley catheter.
Patient (#4)
The patient was observed in her room sitting up in a chair. When asked if she had a bath that morning she denied been offered a bath or water to wash prior to breakfast.
Review of her Nursing assessment notes revealed the patient was able to make her needs known but required assistance with activities of daily living (ADL).
Patient (#3)
Observation revealed Patient # (3) appeared unkempt lying in bed at 12:10 pm . When asked the patient stated she did not yet have a bath . Her mouth was dry and had white debris inside the corners of her mouth. Patient had a 500 cc bag of normal saline on a pump going at 75 cc/hr and a Foley catheter to drain with 1300 cc of urine in the bag.
Review of the Physicians orders revealed no documented indication or orders for Foley Catheter use. Review of Nurses notes revealed no documentation the patient was evaluated for the continued use of a Foley catheter.
Review of Admission Drug reconciliation record dated 7/22/2013 had a yes to continue Normal Saline at 75 cc an hour. Review of staff documentation on fluid record revealed the normal saline had been administered at 75 cc and hour since 7/22/2013. The patient was on Pureed diet with protein drink.
During an interview on 8/5/2013 with the Chief Nursing Officer (CNO) he was not able to tell the indication for the use of the normal saline, he stated the patient might have been getting the fluid for hydration because she was not eating. There was no documentation the patient was evaluated for the continued use of the normal saline.
Patient (#5)
was lying in his rumpled bed with wound care nurse doing dressing change. The Patient was a double amputee, looked unkempt. When asked about his hygiene care the patient stated he was not offered a bath nor was given water to wash his face prior to breakfast that morning.
During an interview on 8/5/2013 / with the CNO he stated the admission orders that checked Foley catheter need to be clear .
Random Observation at that time revealed three of the four patients observed were in bed with four bedside rails in the up position.
Record review revealed there no orders for the restraint use and the patients were not evaluated by the nursing staff for restraint use.
Review of the facility's Urinary Catheter policy/procedure revised 11/20111 revealed the following information that patients on urinary catheter should be:
"Evaluated for the need on an on going basis during their hospital stay and it should be documented."
Review of the facility's Restraint policy/procedure revised 5/22/2013 documented:
"The use of restraint must be in accordance with the order of a physician or other Licensed Independent Practitioner (LIP) who is responsible for the care of the patient and authorize to order restraint by the facility policy and in accordance with state law.
The physician's order must specify the clinical justification for the restraint.
The use of restraints shell result in a written modification of the patient's Care Plan.
The use of restraints will be frequently evaluated and discontinued at the earliest possible time based on the assessment and re-evaluation of the patient's condition."

Based on observation, interview, and record review, the facility failed to comply with its infection control policy to ensure staff maintain Foley catheter drainage bags in a manner to minimize the risk for infection;
Failed to ensure staff clean stethoscope after each patient use and prior to using on other patient;
Failed to ensure staffs sanitize their hands after handling trash from patients ' rooms.
This failed practice had the potential for the spread of infection to patients and staff. Citing random observation on the Medical/Surgical Unit.
Findings:
Observation on 8/5/2013 at 11:45 am on the medical/surgical unit revealed Staff (# C ) a physician making patient rounds had a stethoscope around his neck. The Staff went into the rooms of two patients on contact isolation examined his patients left the rooms and did not sanitize his stethoscope. The physician went into the rooms of two other patients not on isolation used the stethoscope on both patients left their rooms and did not clean the stethoscope after each patient use.
Observation in two (2) patient rooms revealed the patients had Foley Catheter to drainage bags. The urine bags for both patients attached to the Foley Catheters had over a liter of urine in each bag with the bags touching on the floor.
Observation on 8/6/2013 at 9:15 am on the Medical/Surgical unit revealed Staff (D) housekeeping was observed removing trash from patient rooms to the dirty utility room. after dumping the trash and removing his gloves the staff did not sanitize his hands.
During an interview on 8/6/2013 at 10:10 am with The Chief Nursing Officer who was present during the observation he stated the urine bags should have been emptied and were not supposed to be on the floor. He also stated the staff would be re-educated in proper infection control measures.
Review of the facility's infection control policy/procedure revised 9/2011 instructs staff to "wash hands after contact with soiled or contaminated articles, such as articles that are contaminated with body fluids and after removal of medical/surgical or utility gloves."