HospitalInspections.org

Based on surveyor observation, record review and staff interviews, it has been determined that the facility failed to provide evidence of reassessment of the patient's nursing care needs, response to nursing interventions, and revision of the plan of care for relevant sample patient ID #2 relative to weights, and for 1 of 3 relevant sample patient's ID #3 relative to hand splints.

Findings are as follows:

1. Review of the hospital's policy and procedure entitled "Obtaining Patient Heights and Weights" under "Policy" states:

Under item #1, "The weight of all patients will be obtained and recorded on the Height/weight Chart upon admission... Staff will record which scale is used..."

Under item #6, "..All weights are reported to the nurse coordinator or designee. Any weight fluctuation of 5% in one month will initiate a Dietician and Physician notification, and the monitored weight protocol."

Under item #8, "The nurse will document the weight fluctuation in the Nurse's Notes and on the plan of care .."

Record review revealed patient ID #2 was admitted on 12/17/2014, and has a physician's order dated 12/22/2014 which specifies weekly weights.

Additionally, the patient has a current care plan dated 12/22/2014 which indicates he/she has morbid obesity with a goal to lose weight, preferably 6-8 pounds per month. Approaches include monitor weekly weight and record, evaluation and adjust diet as needed.

A review of the unit weight sheets lacked evidence that weekly weights were obtained on 12/28/14, 1/4/15 and 1/18/15.

In addition, a review of the weight sheet revealed the patient weighed 475 pounds on 1/13/2015 and 446 pounds on 1/28/2015, which indicates a 29 pounds weight loss in 2 weeks (6.10 %).

Record review revealed lacked evidence of which scale was used or that the weight was reported to the nurse coordinator. Additionally, there was no evidence that the dietician or physician were notified of the weight loss.

When interviewed on 2/4/2015 at 3:30 PM, the nurse manager was unable to produce evidence that the dietician or physician were notified. Additionally, she was unable to produce evidence that the patient was reassessed after the 29 pound weight loss or that nursing interventions and revision to the plan had been done for this patient.

2. Record review revealed patient ID #3 has a physician's order updated on 2/3/2015, which specifies bilateral rest hand splint 6-8 hours/daytime.

Surveyor observation on 2/5/2015 at 9:15, 9:30, 10:00 10:30, 10:55 and 11:45 AM revealed this patient lying in bed with no evidence of bilateral hand splints.

Surveyor observation in the presence of the unit charge nurse on 2/5/2015 at 12:45 PM revealed the patient lying in bed without the bilateral hand splints. When questioned during this observation, the unit charge nurse indicated she was unaware that the patient had a physician's order for hand splints and was unaware the splints had not been worn.

Subsequent interviews on 2/5/15 at approximately 12:50 PM, with 4 nursing assistants (IDs A, B, C, D) who had been taking care of the patient, revealed they had not applied the hand splints for this patient for the last several months.

During an interview on 2/5/2015 at 3:00 PM, the nurse manager was unable to produce evidence that the patient was reassessed for hand splints, or that nursing interventions and revision to the care plan had been done.

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Based upon record review and staff interview, it has been determined that the hospital failed to maintain medical records that were accurately written and promptly completed for relevant sample patient ID #3 relative to hand splints.

Findings are as follows:

Record review revealed patient ID #3 has a physician's order updated on 2/3/2015, which specifies bilateral rest hand splint 6-8 hours/daytime.

Surveyor observation on 2/5/2015 at 9:15, 9:30, 10:00, 10:30, 10:55 and 11:45 AM revealed the patient lying in bed without the bilateral rest hand splints in place.

Review of the Treatment Flow Sheets from October 2014 through February 2015 revealed the splints were signed off as being applied during this time. A photographic copy of the Treatment Flow Sheet for February 2015 was made by the surveyor at approximately 11:15 AM.

Subsequent interviews on 2/5/15 at approximately 12:50 PM, with 4 nursing assistants (IDs A, B, C and D) who have been taking care of this patient, revealed they have not applied the hand splints to this patient for the last several months; they were unable to explain why the splints were signed off as being applied.

Additionally, at approximately 2:00 PM, the surveyor again reviewed the Treatment Flow Sheet for February and observed that all of the dates that were signed off for February were now circled, indicating the splints had not been applied.

Based on surveyor observation and staff interview, it has been determined that the facility failed to ensure all medications are secured and locked on 1 of 4 nursing units.

Findings are as follows:

Review of the hospital policy and procedure entitled "Appropriate Medication Storage: Medication Rooms" under "Procedure" states:

Item # 1 "Only Nurses and Pharmacy personnel are allowed unattended in the Medication rooms."

Surveyor observation of the second floor Zambarano nursing unit (South), on 2/5/2015 between 1:00 - 1:10 PM revealed a building contractor in the medication room with the door closed. When questioned, he indicated that he was working on the heating system. It was noted that there was no nurse or pharmacy personnel staff in the medication room.

It was noted that the medication refrigerator in the medication room was not locked. In the refrigerator were vials of insulin, Ativan, and suppositories. Additionally, there was a medication cart in the room in which several of the medication drawers containing patients medications had broken locks and could be opened.

At approximately 1:10 PM, one of the nurses on the unit entered the medication room and left a few minutes later, leaving the contractor alone in the room.

During observations from 1:10 - 1:30 PM the surveyor observed the building contractor continued to be alone in the medication room.

On 2/5/2015 at 2:45 PM, the nurse manager was interviewed and was unable to explain why the contractor was left unattended in the medication room.

Based on observation, interview and review of documentation, the facility failed to maintain 1 of 2 dish rooms in a sanitary and safe manner.

Findings are as follows:

Under Chapter 6- Physical Environment of the 2013 Food Code states "the floors , floor coverings, walls, wall coverings and ceilings shall be designed, constructed, and installed so they are smooth and easily cleanable." It also states that "except in areas used only for dry storage, concrete, porous blocks, or brick used for indoor wall construction shall be finished and sealed to provide a smooth, nonabsorbent, easily cleanable surface.

On 2/5/2015 at 9:30 AM, the surveyor, the Food Service Administrator and the cook toured the dish room at the Zambarano Campus. The staff had not begun operating the dish machine at this time. The linoleum type flooring was cracked and was lifting up in several areas. A pool of water was underneath the flooring and was also coming through the rubber mat that was over it.

The ceiling and pipe coverings were peeling/flaking. There were holes in the ceiling, including one around an electrical unit that was not sealed. There was a wall next to the clean end of the dish machine where the tiles were missing, exposing jagged bricks.

During a subsequent interview on 2/5/15 at approximately 9:40 AM, the cook informed the surveyor that a work order was submitted to the Maintenance Shop on 10/1/2013, that stated "holes and cracks in dish room floor, peeling up in some spots around seams."

An additional interview with the Food Service Manager, who is also a Compliance Officer, revealed that this issue had been brought up at the Safety Committee Meeting. Documentation shows that it was presented on 2/18/2014 and again on 12/16/2014: "bids have been placed and the information has been passed along to the appropriate parties."