| 10286 |
BRIAN CENTER NURSING CARE - ST ANDREWS |
425129 |
3514 SIDNEY ROAD |
COLUMBIA |
SC |
29210 |
2010-12-08 |
441 |
E |
|
|
R42P11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, interview and review of facility policies, the facility failed to develop and maintain an infection control program which prevented the spread of infection. During three of four pressure ulcer treatment observations, concerns were identified related to glove use or handwashing. (Resident's # 1, #2, and #5) During observation of three of three gastric tube flushes, the nursing staff failed to clean the stethoscope either before or following the treatment. (Resident's #2, #3, and #8) In two of three medication rooms, supplies were found stored beyond the manufacturer's expiration date. (One hundred and three hundred units) The findings included: The facility last admitted Resident # 1 with [DIAGNOSES REDACTED]. On [DATE] at 10:45AM, Licensed Practical Nurse (LPN) # 5 was observed performing wound care for the resident. LPN # 5 was observed to remove the soiled dressing from the residents left hip area, and without changing gloves proceeded to clean the wound using clean supplies. The facility last admitted Resident # 5 with [DIAGNOSES REDACTED]. On [DATE] at approximately 11AM, Licensed Practical Nurse # 5 was observed performing pressure ulcer care. LPN # 5 removed the soiled dressing from the residents sacrum and without changing gloves proceeded to clean the Stage IV pressure area with clean supplies. After cleaning the area with normal saline and drying the area, LPN #5 removed her gloves, washed her hands and donned clean gloves. The nurse then skin prepped the perimeter of the wound, fanned the area dry, applied Santyl to the areas containing slough, wet a dressing with saline, unfolded it, folded it into a smaller size and placed it directly onto the wound. A cover dressing was applied. LPN #5, continuing to wear the same gloves, reached into her uniform pocket, removed a pen and tape which were used to initial and date the dressing. After moving the bedside table away from the bed, the nurse removed her gloves, placed the tape and pen back into her uniform pocket and then washed her hands. A facility provided QA (Quality Assurance) Worksheet (for) Aseptic Treatment/Dressing Changes stated: "Wear gloves when removing soiled dressings, then discard gloves and dressing." The facility admitted Resident # 2 on [DATE] with [DIAGNOSES REDACTED]. During observation of wound care on [DATE] at approximately 1:30 PM, the Licensed Practical Nurse (LPN # 1) entered the room, pulled the privacy curtain between the beds to the foot of the bed. After cleaning the wound, LPN # 1 discarded the wipes, removed gloves, washed hands, and pulled a pair of gloves from the box on the wall. As LPN # 1 returned to the bedside, his keys fell out of his pocket. He reached over and picked them up with his bare right hand, returned them to his pocket and then put the gloves on without washing his hands again. LPN # 1 then continued to put the clean bandage over the open wound. During an interview with LPN # 1 on [DATE] at approximately 4:00 PM, he confirmed that he had not washed his hands after picking up his keys off the floor during the treatment. The facility admitted Resident # 8 with Anoxic Brain Injury and status Gastrostomy. On [DATE] at 9:55AM, Licensed Practical Nurse # 5 was observed flushing the resident's gastric tube. The nurse walked to the resident's room wearing a stethoscope around her neck. The stethoscope bell was placed directly onto the resident's skin to check placement. The nurse then wrapped the stethoscope around her neck. The bell of the stethoscope was observed to touch the nurses uniform front and also her upper sleeve as the tube flush was administered. The stethoscope remained around the nurses neck. At the completion of the observation, the nurse was asked if she was finished and if she needed to do anything additional. The nurse stated she was "finished." The facility admitted Resident # 2 on [DATE] with [DIAGNOSES REDACTED]. During observation of tube flush on [DATE] at approximately 9:30 AM, Licensed Practical Nurse ( LPN # 1) entered room, explained treatment to Resident # 2, and returned to the hall to get supplies. LPN # 1 picked up a stethoscope from the medication cart and placed it around his neck, then set up the supplies on the over the bed table and proceeded to use the stethoscope to check for placement. At no time did this surveyor observe LPN # 1 cleaning the stethoscope. During an interview with LPN # 1 on [DATE] at approximately 4:00 PM, he stated that he had cleaned the stethoscope after the surveyor left the area, but not before the procedure. The facility admitted Resident # 3 on [DATE] with [DIAGNOSES REDACTED]. During observation of tube flush on [DATE] at approximately 11:30 AM, Licensed Practical Nurse (LPN # 2), entered the room, provided privacy, and set up the supplies on the over the bed table, washed her hands and gloved. She then took the stethoscope from the tube pole and proceeded to check for placement. After using the stethoscope, she returned it to the tube pole and proceeded with the tube flush. She did not clean the stethoscope during or after the procedure. On [DATE] at 3:50 PM, observation of the 300 Hall Medication Room revealed one container of 70 Premoistened Clorox Germicidal Wipes, 6.75 inches by 9 inches, marked "For equipment only", with an expiration date of [DATE]. During an interview on [DATE] at 4:12 PM, Registered Nurse (RN) #1 revealed that the medication nurses were responsible for checking the medication room for expired products. Pharmacy comes once a month and does a total check of the medication rooms. RN #1 stated that the wipes could have been used to clean equipment. On [DATE] at 10:43 AM, observation of the 100 Hall Medication Room revealed a container marked "Disaster Emergency Box", which contained supplies that included two [MEDICATION NAME] Transparent Adhesive Dressings, 6 centimeters by 7 centimeters with an expiration date of ,[DATE]. During an interview on [DATE] at 10:53 AM, Licensed Practical Nurse (LPN) #4 revealed that she (LPN #4) was responsible for checking the medication room for expired products. The medication nurses check the medication room periodically. LPN #3 orders stock medications and monitors stock medication expiration dates. |
2014-01-01 |