cms_NE: 16
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 16 | ST JANE DE CHANTAL | 285004 | 2200 SOUTH 52ND STREET | LINCOLN | NE | 68506 | 2019-06-04 | 880 | E | 0 | 1 | GLUX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.17D Based on observation interview and record review the facility failed to ensure that gloving and hand hygiene was performed when indicated to prevent the potential for cross contamination during treatments for 5 resident (Residents 42,101, 82, 84, 53) an during medication administration for 2 residents (Residents 9 and 51) of 23 sampled residents. The facility census was 115. Findings are: [NAME] An observation on 05/30/19 at 10:30 AM of wound care for Resident 82 revealed; on entry to room, RN I performed hand hygiene by using the hand sanitizer and donned gloves, RN I removed the packing from the wound and doffed gloves and without hand hygiene donned gloves. RN I used soap and water on a wash cloth to cleanse the wound. RN I rinsed the wound with wound cleanser. RN I changed doffed gloves and without hand hygiene and donned gloves. RN I applied skin prep ([MEDICATION NAME] no sting) to the skin surrounding the wound and applied gauze soaked with Vashe (a wound solution that has a skin friendly PH) into the wound. RN I doffed gloves and without hand hygiene donned gloves. RN I applied 4x4 Vaseline gauze applied and 4x4 followed by an ABD (Abdominal Pad thick dressing used for draining wounds) RN I doffed gloves and without hand hygiene donned gloves. RN I removed the dry Therabond (a wet to dry dressing used to help debride wounds) from the wound, cleansed the wound with soap and water, no glove change or hand hygiene was performed, a new piece of Therabond was cut to size, moistened and placed over wound. RN I doffed gloves and without hand hygiene donned gloves. RN I assisted with Resident 82's repositioning. RN I replaced supplies, cleansed table with wipes (Sani). RN I used hand sanitizer was used. B. An observation on 5/30/19 at 10:50 AM of wound care for Resident 101 performed by LPN (Licensed Practical Nurse) J of wound care for Resident 101. LPN J used hand sanitizer on entry to the room. LPN J donned gloves, had wet wash cloths. LPN J removed the dressing from the buttock wounds. LPN doffed gloves and without hand hygiene donned gloves. LPN J patted the wound with soap and water wet cloths. LPN doffed gloves and without hand hygiene donned gloves. The new dressings were prepared by soaking the Surgifoam (an absorbable gelatin sponge used for bleeding wounds) soaked with triple antibiotic ointment. LPN doffed gloves and without hand hygiene donned gloves. LPN J applied ointment and the soaked Surgifoam to the wounds. LPN J doffed gloves and without hand hygiene donned gloves and applied a third soaked Surgifoam sponge and moistened gauze was to the coccyx area. LPN doffed gloves and without hand hygiene donned gloves. LPN J assisted with dressing Resident 101. LPN J doffed gloves and used hand sanitizer. C. An observation on 6/3/19 at 12:55PM of medication administration by RN K for Resident 51 revealed hand hygiene was not performed prior to the medication administration. RN K measured the medications [MEDICATION NAME] 30mL (Milliliters metric system used to measure medications). RN K donned gloves. RN K measured tap water 100mL. RN K checked residual and equaled 60MmL and this was replaced. RN K mixed approximately 30mL of water with the measured medication and drew it into the syringe. No flush was performed by RN K. RN K administered the medication/water mixture by push and the remainder of the water was administered via gravity flow. D. An observation on 6/4/19 at 12:00PM of medication administration by LPN H revealed hand hygiene was not performed prior to entry to the room for medication administration. Record review of infection prevention Hand Hygiene policy dated with review date of 4/19/19 revealed; when hands were visibly soiled or contaminated with protienaceous material or visibly soiled with blood or other body fluids wash hands with soap and water. Step: 1) Vigorously lather hands with soap and rub for 15 seconds under a moderate stream of running water at a comfortable water temperature. 2) Rinse hands thoroughly, hold hands down lower than wrists, do not touch the inside of the sink 3) Dry hands thoroughly with paper towel and then turn off faucets with those towels. 4) Discard towels into the trash do not dry hands with same towel used to turn off sink. If hands are not visibly soiled alcohol based hand rub may be used for routinely decontaminating hands using the following process 1) Apply enough product to thoroughly wet both hands to the palm of one hand. 2) Rub hands together covering all surfaces of hands and fingers until hands are dry. Use alcohol based hand rub or wash hands: 1) When coming on duty. 2) Before performing invasive procedures. 3) Before preparing or handling medications, 4) Before performing dressing care, 5) Before touching preparing or serving food, 6) Before and after having contact with patient or patient environment. 7) After contact with patients on isolation, 8) After handling used dressing, urinals, bedpans catheters, contaminated tissues, linen, or patient care item. 9) After offering incontinence care, Foley care. 10) Before and after manipulation of feeding tubes. 11) Before and after manipulation of IV sites even when wearing gloves. 12) Before and after empty Foley catheter or tubing even when wearing gloves. 13) After contact with blood, urine, feces, oral secretions, mucous membranes or broken skin, 14) After handling items potentially contaminated with any patient blood excretions or secretions. 15) After personal body function use of toilet, blowing nose, wiping nose, smoking or combing hair. 16) Before and after eating. 17) Upon completion of the day. E. Record review of Resident 53's physician progress notes [REDACTED]. Record review of Resident 53's Transfer/Discharge/Active Orders dated 5/29/19 revealed [MEDICAL CONDITION] (a surgically created opening through the neck into the windpipe with a tube place to provide an airway and to remove secretions from the lungs) care was ordered to be done 2 times per day. Observation on 6/3/19 at 9:45 AM of RN-B (Registered Nurse) and RN-C providing [MEDICAL CONDITION] care for Resident 53 revealed RN-B and RN-C used hand sanitizer and applied masks and gloves. RN-B removed the dressing from the [MEDICAL CONDITION] and discarded, then changed gloves without performing hand hygiene. RN-B cleaned around the edge of the [MEDICAL CONDITION] using swab sticks, discarding after use. RN-B changed gloves without performing hand hygiene. RN-B and RN-C removed the [MEDICAL CONDITION] ties (a band that goes around the neck to hold the [MEDICAL CONDITION] in place) and RN-C held the [MEDICAL CONDITION] while RN-B washed and dried the resident's neck. RN-B got the new [MEDICAL CONDITION] tie and RN-B and RN-C secured the [MEDICAL CONDITION]. RN-B changed gloves without performing hand hygiene and applied the new [MEDICAL CONDITION] dressing, then removed gloves and performed hand hygiene. RN-B offered suctioning (removes thick mucus and secretions from the trachea), but Resident 53 refused. F. Review of Resident 42's Pressure Ulcer/Wound record dated 5/29/19 revealed the resident had a closed stage 3 pressure injury (full thickness skin loss where subcutaneous fat may be visible but bone, tendon, or muscle are not exposed) to the right ankle, a closed stage 2 pressure injury (partial thickness loss of skin presenting as a shallow open ulcer with a red/pink wound bed), and unstageable deep tissue injuries (purple area of discolored intact skin due to damage of underlying soft tissue) to the left 5th toe, back of the right ankle, and back of the left ankle. The resident also had a partial thickness (loss of skin presenting as a shallow open ulcer with a red/pink wound bed) wound to the right shin. The resident also had a surgical incision to the right buttock. Record review of Resident 42's Transfer/Discharge/Active Orders dated 5/29/19 revealed the resident received Xeroform (dressing used to maintain a moist wound environment) and [MEDICATION NAME] (absorbent foam dressing) to the wounds on the back of the right and left ankles, on the left foot, and on the right shin. The resident also received Nutrashield lotion to the intact incision line and [MEDICATION NAME] AG (dressing impregnated with silver) to the small open area near the perineum. Observation on 05/30/19 at 11:01 AM of RN-E completing wound care for Resident 42 revealed RN-E cleaned the scissors used for cutting the dressings, performed hand hygiene, and gathered supplies for the dressing change. RN-E applied gloves and pulled the resident's blankets back and removed the prafo boot (boot that alleviates pressure from the heel) from the resident's left foot. RN-E removed the dressing from the back of the resident's ankle. RN-E removed gloves, used hand sanitizer, and applied new gloves. RN-E cleansed the area with a wash rag, cut a piece of Xeroform to the size of the wound and applied to the wound bed, and covered with a [MEDICATION NAME] dressing. RN-E removed the dressing from the resident's left foot, cleansed the area with a wash rag, cut a piece of Xeroform to the size of the wound, then applied to the wound and covered with a [MEDICATION NAME] dressing. RN-E changed gloves without performing hand hygiene, inspected the resident's heels and applied Nutrashield lotion to the foot. RN-E reapplied the resident's prafo boot and changed gloves without performing hand hygiene. RN-E removed the prafo boot from the resident's right foot and removed the dressing front the resident's right shin. RN-E cleansed the wound and changed gloves without performing hand hygiene. RN-E cut Xeroform to the size of the wound and applied, then covered with a [MEDICATION NAME] dressing. RN-E changed gloves without performing hand hygiene and lifted the dressing to the right ankle, observed the wound, then secured the same dressing back into place. RN-E then secured the prafo boot back onto the resident's foot. RN-E changed gloves without performing hand hygiene, and cleaned the bandage scissors. NA-F (Nurse Aide) entered the room and assisted RN-E with repositioning the resident to the side. RN-E removed the dressing from the surgical incision on the resident's buttock and cleansed the area with a washrag. RN-E applied Nutrashield lotion to the incision, cut a piece of [MEDICATION NAME] AG to size and applied it to the open area at the end of the incision. RN-E and NA-F then continued to give the resident a bed bath. [NAME] Review of Resident 84's Pressure Ulcer/Wound report dated 5/29/19 revealed the resident had an pressure injury to the right hip, a closed stage 2 pressure injury to the sacrococcyx (bottom of the spine to the tailbone), and a stage 3 pressure injury to the right ankle. Resident 84 also had wounds due to skin graft surgery to the right thigh, right hip, and left thigh. Review of Resident 84's Transfer/Discharge/Active Orders dated 5/29/19 revealed the resident received Xeroform secured with gauze to the right thigh, Xeroform covered with [MEDICATION NAME] to skin treated with skin prep swabs to the right hip, right ankle, and left thigh, and [MEDICATION NAME] and skin prep swabs to the coccyx. Observation on 5/30/19 at 2:13 PM of LPN-G (Licensed Practical Nurse) and RN-D performing Resident 84's wound care revealed LPN-G performed hand hygiene and gathered the supplies needed for the dressing change. LPN-G applied gloves and removed the resident's right prafo boot. LPN-G removed the dressing to the resident's right ankle, changed gloves without performing hand hygiene, and cleansed the wound. LPN-G prepped the skin surrounding the wound with a skin prep swab, changed gloves without performing hand hygiene, and cut Xeroform to fit the wound and applied it, then covered the wound with a [MEDICATION NAME] dressing. LPN-G changed gloves without performing hand hygiene and removed the dressings from the resident's right hip. LPN-G changed gloves without performing hand hygiene and cleansed the wound. LPN-G swabbed the skin surrounding the wound with skin prep and changed gloves without performing hand hygiene. LPN-G cut Xeroform to fit the lower right hip wound, applied to the wound, then covered both wounds with [MEDICATION NAME] dressings. LPN-G changed gloves without performing hand hygiene. The resident repositioned in bed and LPN-G removed the dressing from the resident's coccyx. LPN-G changed gloves without performing hand hygiene, cleansed the wound then changed gloves without performing hand hygiene. LPN-G applied a [MEDICATION NAME] dressing to the wound, changed gloves without performing hand hygiene, and secured the resident's brief. LPN-G and RN-D assisted the resident with repositioning, then LPN-G removed the wrap from the resident's left thigh, and changed gloves without performing hand hygiene. LPN-G cleansed the wound and prepped the skin surrounding the wound with the skin prep swab. LPN-G then changed gloves without performing hand hygiene, cut Xeroform gauze to fit the size of the wound, applied the Xeroform to the wound and covered the wound with a [MEDICATION NAME] border dressing. LPN-G changed gloves without performing hand hygiene, wrapped the resident's thigh with gauze, and assisted the resident with repositioning. LPN-G then removed gloves and used hand sanitizer. Review of Standard Precautions Guide dated 3/2018 revealed hand hygiene was required after glove removal, and gloves changes were required moving from a dirty to a clean task. Interview on 6/3/19 at 12:29 PM with RN-D revealed the expectation was that staff would use hand sanitizer or wash hands between glove changes. | 2020-09-01 |