| 1287 |
ARBOR CARE CENTERS-NELIGH LLC |
285124 |
PO BOX 66, 1100 NORTH T STREET |
NELIGH |
NE |
68756 |
2019-03-11 |
880 |
K |
0 |
1 |
UV2T11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.17(17B) (17D) Based on observation, interview, and record review; the facility failed to 1) prevent potential cross-contamination of blood borne pathogens related to the use of a glucometer for Residents 3 and 7, 2) wash hands and change gloves at appropriate intervals during the provision of catheter cares for Resident 14 and incontinence cares for Resident 33, and 3) store respiratory equipment in a sanitary manner for Residents 14, 25, 32, and 21. The sample size was 7 and the facility census was 36. Findings are: [NAME] Review of the undated Blood Glucose Monitoring Competency provided by the facility revealed the following procedure: - Wash hands and apply gloves, - set up a clean field for the glucometer supplies, - turn on the glucometer, - disinfect the resident's finger with an alcohol swab, - insert the test strip into the meter, - puncture the skin with a lancet, - wipe the first drop of blood with a cotton ball, - apply pressure to the finger to collect the blood sample with the glucometer, - clean the resident's finger with a cotton ball and apply pressure until the bleeding stops, - remove the test strip and dispose of it and the lancet into a biohazard container, - remove gloves and wash hands, and - disinfect the glucometer according to manufacturer's instructions. Review of the undated Assure Platinum Blood Glucose Monitoring System User Instruction Manual provided by the facility revealed the following: - Option 1 was to clean and disinfect the glucometer at one time using an EPA-registered disinfectant detergent or germicidal wipe. - To use a wipe, remove it from the container and follow the product label instructions to disinfect the glucometer. - Option 2 was to clean the glucometer first with soapy water or [MEDICATION NAME] alcohol and then disinfect it with a diluted bleach solution or a bleach wipe with a 1:10 concentration. B. Review of Resident 3's current Care Plan with a review date of 12/14/18 revealed the resident had liver disease related to a [DIAGNOSES REDACTED]. It is spread by contaminated blood and may have no visible symptoms). Interventions included: - Dietary consult for recommendations and teaching, - give medications for nausea and vomiting, - provide medications as ordered, - notify the physician of any abnormal vital signs, - monitor for jaundice, - monitor for signs of internal bleeding, - monitor for signs of infection, - weigh weekly, - monitor for signs of complications, and - obtain lab as ordered. A blood glucose monitoring observation was completed on 3/7/19 at 11:30 AM. Licensed Practical Nurse (LPN) -E gathered supplies, washed hands, and applied gloves. LPN-E then entered Resident 3's room and placed the supplies on a paper towel on the resident's bed. LPN-E cleaned the resident's finger with an alcohol prep pad and then pricked the resident's finger with the lancet. LPN-E put pressure on Resident 3's finger to express enough blood for testing and placed the blood on the glucometer test strip. The resident's blood sugar was noted to be 230, the test strip was removed and discarded. The blood on the resident's finger was cleaned off and LPN-E (prior to changing gloves) carried the glucometer and the lancet out of the room. The glucometer was set on a paper towel on the medication cart and the lancet was disposed of in the sharps container. LPN-E's gloves were then removed and hands washed. LPN-E took an alcohol prep pad and wiped the outside of the glucometer (the alcohol dried immediately on contact) and with bare hands placed the glucometer inside the medication cart ready to be used by this or another resident. During an interview with LPN-E on 3/7/19 at 11:35 AM, LPN-E confirmed the glucometer was cleaned using an alcohol wipe. LPN-E stated Clorox wipes were normally used but they didn't have any available at that time. During an interview with the Director of Nursing (DON) on 3/7/19 at 1:45 PM, the DON revealed each unit had 1 glucometer to share among the residents on that unit. Review of a list provided by the facility Accuchecks by Hall (undated) revealed the BC hallways had 2 residents (Residents 3 and 7) that shared a glucometer. Review of Resident 3's Medication Administration Record [REDACTED]. Review of Resident 7's MAR indicated [REDACTED]. During an interview with LPN-G on 3/7/19 at 1:57 PM, LPN-G stated the glucometers should be cleaned with Clorox wipes. Interviews with LPN-H on 3/7/19 from 2:03 PM to 2:10 PM revealed the wipes that were normally used for the glucometers hadn't been available for about a week. LPN-H stated that until the normal glucometer wipes are available they were to use the Clorox wipes. LPN-H then showed the Clorox wipes being used and they were the Clorox Disinfecting Wipes. LPN-H was unaware of the amount of contact time that the glucometer should remain wet to ensure it was disinfected. During an interview with the DON on 3/7/19 at 2:08 PM, the DON confirmed Resident 3 had [MEDICAL CONDITION] and was unaware of any treatment the resident had received for this (which indicated the resident was still contagious). The DON confirmed the facility ran out of the proper glucometer cleaning wipes and the staff were told to use Clorox wipes in the meantime. Further interview confirmed alcohol wipes should not be used to disinfect the glucometer. The immediate jeopardy was abated to an [NAME] level on 3/7/19 at 4:30 PM when: 1) The facility found the proper cleaning wipes (Sani-Cloth Germicidal Disposable Wipes) in the supply room and placed them in the medication carts. 2) All available nurses and medication aides were trained on the proper cleaning of glucometers. For those staff that hadn't been trained yet there was a plan in place to ensure they were trained prior to working again. 3) A bulk order for Sani-Cloth Germicidal Disposable Wipes cleaning wipes was placed to ensure the facility didn't run out again. 4) A plan to get each resident their own glucometer was developed. 5) A plan was developed for audits to ensure continued compliance. C. Review of the facility policy titled Hand-Washing/Hand Hygiene with revision date 8/14, revealed the facility considered hand-washing/hand hygiene the primary method of preventing the spread of infections included [REDACTED]. -before and after direct contact with residents; -when hands are visibly soiled or dirty (with soap and water); -before and after assisting a resident with personal cares; -before and after assisting a resident with toileting; -before handling soiled equipment; and -before putting on clean gloves and after removing soiled gloves. D. During observation of nursing care on 3/5/19 at 1:31 PM, Nursing Assistant (NA)-C and NA-B provided incontinence cares for Resident 33. NA-C provided perineal hygiene, but without removing soiled gloves, placed a clean urinary incontinence brief on the resident, adjusted the resident's clothing, assisted the resident to position on the resident's right side, placed a pillow between the resident's legs and another pillow beneath the resident's head, removed the resident's shoes, covered the resident with a blanket, gave the resident a call light cord and used the bed controls to lower the resident's bed. NA-C finally removed soiled gloves and washed hands in the resident's bathroom. E. During observation of catheter cares for Resident 14 on 3/6/19 at 8:01 AM, NA-L and LPN-G washed hands and donned clean gloves. LPN-G completed urinary catheter cares and then removed soiled gloves. Without washing or sanitizing hands, LPN-G proceeded to reposition Resident 14 in bed, adjusted the resident's clothing and covered the resident with a blanket. LPN-G then returned to the resident's bathroom to wash hands F. Observations of Resident 14's room throughout the survey revealed the following: -3/5/19 from 8:36 AM to 12:36 PM, an oxygen concentrator was positioned next to the resident's bed. Oxygen tubing connected to the concentrator was positioned directly on the floor and draped on the side of the concentrator with the end of the tubing and a nasal cannula coiled on top of the concentrator. The oxygen tubing and nasal cannula were uncovered. In addition, a gallon jug of distilled water was stored directly on the floor next to the concentrator. -3/6/19 at 8:20 AM, the oxygen concentrator remained next to the resident's bed. The oxygen tubing was lying directly on the floor between the concentrator and the resident's bed. The end of the oxygen tubing and the oxygen cannula were draped across the resident's bed linens and pillow. [NAME] Observations of Resident 21's room throughout the survey revealed the following: -3/4/19 at 11:25 AM, a nebulizer machine (a drug delivery device used to administer medication in the form of a mist inhaled into the lungs) was positioned on top of the bedside dresser. The mask for the nebulizer was connected to the machine and there were droplets of moisture visible on the inside surface. The mask was uncovered and had been wedged in an upright position in the top drawer of the dresser. -3/5/19 at 2:12 PM, the nebulizer machine remained on top of the bedside dresser. The mask remained uncovered and was hanging down the side of the dresser. -3/6/19 at 8:36 AM, the nebulizer machine continued to be stored on the top of the bedside dresser. The nebulizer mask was uncovered and was also stored directly on top of the dresser as well. The mask had been placed in a face down position so the surface of the mask which would come in contact with the resident's face was lying directly on the surface of the dresser. During interview on 3/11/19 at 9:20 AM, the DON verified the facility policy was to rinse the nebulizer mask after each treatment, allow it to dry, then store it in a plastic bag and the oxygen tubing and nasal cannula should always be stored in a plastic bag. In addition, the DON confirmed staff members were expected to remove soiled gloves and wash/sanitize hands following provision of resident cares. H. During observations on 3/5/19 from 7:44 AM until 1:45 PM, the following were observed: -there was a shelf located immediately to the right of the handwashing sink shared by Residents 32 and 25 that had a nebulizer mask and medication receptacle stored uncovered on a washcloth laid on top of the shelf; and -there was a nebulizer mask and medication receptacle stored uncovered on a washcloth laid on the ledge between the window glass pane and the blinds that were drawn closed in Resident 25's room. This practice caused potential contamination of the residents' nebulizer equipment from water spatter and/or other debris. |
2020-09-01 |