HospitalInspections.org

Based on observation and record review on 02/27/2019 the facility failed to ensure incapacitated patients had another designated individual to make informed decisions about their care and sign consents.
Two (2) out of 18 patients' (#2, #3) medical records reviewed revealed consents were not signed by a designated representative.

Findings included:

Record review of patient (#3), who was admitted on 01/15/19 revealed patient (#3's) fiancé signed a consent for modified life support, (do not resuscitate /code status) as well as other consents (ten consents) for wound care, hemodialysis, blood administration, and other procedures, dated from 01/15/19 to 02/18/19.

Patient (#3) did not have a power of medical attorney available on the chart

Interview on 02/27/2019 at 1330 with (staff #1), Register Nurse (RN), Chief Nursing Officer, who stated, "there is no power of attorney for medical care in the chart."

Record review of patient (#2), who was admitted on 02/18/2019 was confused, and signed his consents for a procedure on 02/24/2019 (central line insertion).

Patient's (#2) medical dated 02/25/2019 and 02/22/19 by physician (#60), documented patient (#2) was markedly confused.

Record review of patient (#2) nursing notes dated 02/23/2019 by staff (#61), Licensed vocational nurse (LVN) and on 02/24/2019, staff (#62) LVN, both documented patient (#2) was confused.

Interview on 02/27/2019 at 1230 with staff (#53), RN, the house supervisor, she stated, "yes, he is pleasantly confused."

Record review of the hospital policy "Consent for Medical and Surgical Procedures" dated 09/02/2013 revealed;

The role of nursing in the informed consent process is to obtain the signature on the consent form and witness the signature, after ascertaining that the patient has been informed.

A witness signature indicates: the person giving consent is competent, oriented to time and place, lucid and understands that they are signing consent for treatment, medical/surgical procedure form.

For patients whose capacity to consent is uncertain, consent should be obtained from the patient and the next legally authorized representative.

Based on observation and interview on Wednesday, 02/28/2019 the facility failure failed to maintain an effective system to control infection. The facility failed to maintain three (3) hand sanitizers and a one (1) working sink on a 35 bed unit.

Findings Included:

Observation on 02/27/2019 revealed nonfunctioning hand sanitizers:

Near the nurse's station on the 3rd floor
Outside of room 236
Outside the procedure room 223
Inside room 227
Near elevator # 3 and a
Nonworking sink in the nourishment room.

Observation on 02/27/2019 at 1345 of staff member (#59), LVN, dialysis technician by both the surveyor and staff member, RN (#1), was observed leaving patient room 320 did not gel out as he left the room.

Interview on 02/27/2019 at 1347 with staff member (#59), LVN, dialysis technician, stated he was "sorry".

Interview on Wednesday, 02/27/2019 at 1220 with staff member (#58), regarding the broken sink in the nourishment room, he stated "yes it's not working and it's been that way since Sunday (02/24/2019)."

Record review of the facility policy "Hand Hygiene" dated 01/19 stated:

Indications for hand washing and hand antisepsis:
Before and after direct contact with patients, blood/body fluids or equipment and environmental items that are likely to be contaminated.