| 26 |
HIGHLANDS HEALTH AND REHAB |
15012 |
380 WOODS COVE ROAD |
SCOTTSBORO |
AL |
35768 |
2019-06-06 |
880 |
D |
0 |
1 |
3PTZ11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, medical record reviews and review of facility policies titled, Universal Precautions and Hand Hygiene, the facility failed to ensure: 1) a licensed nurse washed her hands when removing gloves after obtaining Resident Identifier (RI) # 9's fingerstick blood sugar (FSBS) and before leaving RI #9's room to return to the medication cart. Further, the nurse failed to use a barrier when laying an insulin syringe with RI #9's insulin and alcohol wipe on the bathroom sink; and 2) a licensed nurse did not place a medication cup containing medication for RI #23 inside another medication cup containing the remainder of RI #23's medication. Further, the nurse did not use a barrier before placing RI #23's Salonpas patches and [MEDICATION NAME] on the top of the medication cart, computer and a shelf in RI #23's room. These deficient practices affected RI #9 and RI #23, two of four residents and two of three nurses observed during medication pass observations. Findings Include: 1) A review of a facility policy titled, Hand Hygiene, Last Revised: 02/2019, documented: .B. Indications for hand washing and hand antisepsis .3. Perform hand hygiene: a. before and after having direct contact with patients; b. after removing gloves; before handling an invasive device (regardless of whether or not gloves are used) for patient care; .f. after contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient; . A review of a facility policy titled, Universal Precautions, Last Revised: 02/2019, revealed: .[NAME] Hand Washing .3. Hands should be sanitized immediately after gloves are removed. B. 1. Gloves should be worn for touching blood and body fluids, . 1.) RI #9 was readmitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 06/05/19 at 5:04 p.m., the surveyor observed Employee Identifier (EI) #7, Registered Nurse (RN), during medication pass for RI #9. The surveyor observed EI #7, RN, obtain RI #9's FSBS and remove her gloves without washing her hands and returned to the medication cart to prepare RI #9's insulin injection. EI #7 was then observed entering RI #9's bathroom and laying the syringe filled with insulin and the alcohol wipes beside the bathroom sink without a barrier. On 06/05/19 at 5:17 p.m., an interview was conducted with EI #7, RN. EI #7 was asked when should she wash her hands when wearing gloves. EI #7 said she should wash them when she takes them off. EI #7 was asked did she wash her hands after obtaining RI #9's FSBS and removing her gloves before returning to the medication cart. EI #7 stated no. EI #7 was asked what should she do before laying anything down on any surface. EI #7 replied she should put down a barrier. EI #7 was asked did she put down a barrier before she laid the insulin syringe and alcohol wipe beside the sink. EI #7 stated no she did not. EI #7 was asked what was the concern with laying things down on surfaces without a barrier. EI #7 answered, it could be dirty and there could be germs. 2.) RI #23 was readmitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 06/06/19 at 8:39 a.m., EI #3, RN, was observed during medication pass for RI #23. EI #3 was observed removing two of RI #23's Salonpas patches from the packet and laying them on top of the medication cart without a barrier to initial and date them. EI #3 removed the nitro dur patch from the packet and laid it on top of the computer on the medication cart to initial and date it. EI #3 was then observed placing a medication cup containing [MEDICATION NAME] and placing it inside another medication cup containing the remainder of RI #23's pills. EI #3 entered RI #23's room and placed the items on a shelf unit inside the room without placing a barrier. On 06/06/19 at 9:21 a.m., an interview was conducted with EI #3, RN. EI #3 was asked what was the concern with placing a medication cup inside another medication cup containing medications. EI #3 said dirty stuff could be on them, infection control. EI #3 was asked what was the concern with placing Salonpas and nitro patches on the computer and on top of the medication cart to date them. EI #3 replied again, getting them dirty. EI #3 was asked did she place the Salonpas and nitro patch on her computer, top of the medication cart and on the shelving unit in RI #23's room without a barrier. EI #3 said yes. On 06/06/19 at 3:47 p.m., an interview was conducted with EI #5, RN/Director of Nursing. EI #5 was asked, when should nurses wash their hands when wearing gloves. EI #5 said as soon as the gloves come off the hands should be washed. EI #5 was asked should a medication cup containing medications be placed inside another medication cup containing medications. EI #5 replied no. EI #5 was asked should patches be placed on a shelving unit without a barrier. EI #5 stated no. EI #5 was asked what was the concern with those things. EI #5 answered infection control and cross contamination. |
2020-09-01 |