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Based on medical record review and interview, the facility failed to ensure a physician's telephone order contained the required elements for a medication revision for one patient (#20) of twenty medical records reviewed.

The findings included:

Patient # 20 was admitted to the facility on December 1, 2011, with diagnoses to include Dementia.

Medical record review of the attending Physician's Order dated December 3, 2011, at 1:50 p.m., revealed "increase Trazadone (antidepressant often used as a sleep aide) to 150 mg (milligrams) po (by mouth) qhs (every night)

Medical record review of the Nurse's Notes, dated December 23, at 10:35 p.m., revealed the patient had been found unresponsive and was sent to the Emergency Department (ED) for evaluation by the ED physician.

Medical record review of the ED Physician's Order, dated December 3, 2011, at 11:00 p.m., revealed "Patient medically cleared ...Hold p.m. meds (medications) until (named physician) can review the events of tonight and make adjustments."

Medical record review of the attending Physician's Order, dated December 4, 2011, at 3:35 p.m., of a "telephone order" revealed "Continue with current medications and dosage"

Interview with the Pharmacist on December 6, 2011, at 11:35 a.m., in the pharmacy, confirmed the telephone order, written December 4, 2011, at 3:35 p.m., "Continue with current meds", was not accurately written to include all information to make the order clear or complete. Continued interview confirmed the lack of all necessary information in order was not acceptable practice for writing a medication order.

Based on medical record review, facility policy review, and interview, the facility failed to ensure the consent for anesthesia was completed to include the type of anesthesia to be utilized for one (#19) of twenty patients reviewed.

The findings included:

Patient #19 was admitted on December 6, 2011 for out-patient surgery to include Excision of Right Breast Mass.

Medical record review revealed the Consent for Anesthesia was signed by the patient and dated December 6, 2011. Continued review revealed the type of anesthesia to be utilized was not checked on the consent form.

Review of the facility policy Informed Consent, #1003, dated as revised July 2004, revealed " ...the [patient must be given the opportunity to give "informed consent" prior to the administration of anesthesia ...Must consist of: ...nature of treatment ...patient has been informed about the anesthesia ...responsibility of the anesthesiologist and/or treating physician to obtain consent ...the blanks have been filled in with the necessary information ..."

Interview with the Circulating Operating Room Nurse, on December 6, 2011, at 9:30 a.m., in the Recovery, confirmed the patient received "General Anesthesia" (patient is rendered completely unconscious and requires the anesthesia personnel to maintain the patient respirations). Continued interview confirmed the Anesthesia Consent form was not completed to include the type of anesthesia the patient received.

Based on observation, review of national standards, and interview, the facility failed to ensure the required amount of Dantrium was available in the Operating Room (OR) Malignant Hyperthermia tray.

The findings included:

Observation of the Malignant Hyperthermia (emergency condition requiring immediate treatment triggered by some anesthesia agents which causes muscle stiffness/regidity and a rapid elevation in the patient's body temperature) tray in the Operating Room on December 5, 2011, at 3:30 p.m., revealed the tray contained 18 vials of Dantrium (used to decrease muscular rigidity).

The Malignant Hyperthermia Association of the United States (MHAUS) recommends a minimum stocking level of 36 vials of dantrolene sodium for injection (Dantrium® IV) for facilities that use triggering agents.

Interview in the OR on December 5, 2011, at 3:30 p.m., with the Chief Nursing Officer, confirmed the tray only contained 18 vial of Dantrium.

Based on observation and interview, the facility failed to ensure open medications and fluids for irrigation were dated when opened; and failed to ensure expired medications, sutures , fluids for infusion, and wound packing gauze located in the Emergency Department (ED) were not available for patient use.

The findings included:

Observation of the ED on December 5, 2011, between 11:00 a.m. and 2:00 p.m., revealed the following items open and undated: 1000 ml (milliliters) container of Sterile Water for Irrigation (of wounds or open tissue areas) - 1/8 full; 1000 ml container of 0.9% Sodium Chloride for Irrigation (of wounds or open tissue areas) - 1/2 full; open container of 1/2 inch Plain Packing Gauze (for packing wounds); open tube of Gentamycin Ophthalmic ointment (eye antibiotic), open tube of Tetracaine Hydrochloride Ophthalmic ointment (eye anesthetic), open tube of Natural Tears (eye lubricant); and two pediatric EKG (Electro Cardio Graph) pads.

Interview in the ED on December 5, 2011, between 11:00 a.m., and 2:00 p.m., with the Chief Financial Officer (CFO) and ED Charge Nurse confirmed the items had been opened; were not dated when opened; and were to be dated when opened.

Observation of the ED on December 5, 2011, between 11:00 a.m. and 2:00 p.m., revealed one bag Dextrose 5% 150 ml IVF (intravenous Fluid) - expired February 2008 and five bags - expired June 2008; one bottle of 1 inch Plain Packing Gauze - expired February 2011; seven packs of 2-0 Plain Gut sutures with no expiration date listed; one Transport Swab (for culture) - expired June 2011; one tube Neomycin/Polymycin B Ophthalmic ointment - expired November 2011; and 6 packs of pediatric EKG pads - expired August 2011.

Interview with the CFO and ED Charge Nurse in the ED on December 5, 2011, between 11:00 a.m. and 2:00 p.m., confirmed the irrigation fluids, packing gauze, medications, and EKG pads were open and undated. Continued interview confirmed the IVF's, packing gauze, sutures, culture swab, and medications had expired and were available for patient use.

Interview with the facility Pharmacist in the pharmacy on December 6, 2011, at 11:15 a.m., confirmed the identified open and undated were to be dated when opened and expired items were not to be available for patient use.

Interview with the Chief Nursing Officer on December 6, 2011, at 2:50 p.m., in the conference room confirmed all items identified were to be dated when opened; and all patient care items identified as expired were not to be available for patient use.

Based on observation and interview, the facility failed to ensure flammable chemicals were separated from food service items in a storage area of the kitchen.

The findings included:

Observation of a storage area in the facility kitchen on December 6, 2011, at 2:40 p.m., revealed 4 cans of (named) food heating element source and 5 containers of charcoal lighter located on the shelf with food service items such as serving trays and bowls.

Interview in the storage area with the facility cook on December 6, 2011, at 2:40 p.m., confirmed the storage area contained food service supplies and the flammable chemicals were stored on the shelf with food service items. Continued interview confirmed the flammable chemicals were not to be stored with food service items.

Based on observation and interview, the facility failed to maintain separation of clean and soiled supplies in the Emergency Department (ED); and failed to maintain a cooking area free of dust build up in the kitchen.

The findings included:

Observation of a drawer in the ED nursing station on December 5, 2011, at 11:30 a.m., revealed various patient use supplies such as devices to measure wounds, a percussion hammer, and finger splints located in direct proximity to such soiled items as screw drivers, pliers, and a paperclip remover.

Interview in the ED with the Chief Financial Officer and the ED Charge Nurse on December 5, 2011, at 11:30 a.m., confirmed clean and soiled supplies were not to be stored together. Continued interview confirmed the drawer at the ED nursing station contained clean patient supplies located in direct proximity to soiled items.

Observation in the facility kitchen on December 6, 2011, at 2:10 p.m., of the stove hood in the kitchen revealed a build-up of dust on the sprinklers and lip of the stove hood. Continued observation revealed an uncovered pot of beans cooking on the stove.

Interview with the facility cook on December 6, 2011, at 2:10 p.m., confirmed the build-up of dust on the stove hood presented cleanliness problems for cooking foods.