Fairview Care Center Of Bethlehem Pike
Based on observation, review of the Professional Nurse Practice Act, facility policies and procedures and interviews with staff, it was determined that the nursing home failed to adhere to the standards of the Nursing Practice for enteral medication administration for one of its 27 residents. The findings included the following: The Pennsylvania Code, Professional and Vocational Standards, states that a registered nurse is responsible for carrying out nursing care which promotes, maintains and restores the well-being of individuals and responsible for all actions as a registered nurse and is accountable for the quality of care delivered. Code 21: 145 states that a licensed nurse has the necessary knowledge, preparation, experience and the competency to properly execute the practice, and document and maintain accurate records. On November 3, 2012, at approximately 1:30 p.m. as ordered by the physician, Employee E4 was observed administering medicine used to treat a diagnosed condition at a total of 25 mg. Employee E4 immediately withdrew 50 cc of water into a syringe and injected the solution into a tube without placing a stethoscope over the resident’s epigastric region to determine if sounds can be heard to determine proper placement of the tube.
Employee E4 also failed to check for residual by aspirating the stomach contents in order to determine the amount of residual before introducing more fluids into the stomach. During the procedure, Employee E4 was observed rapidly injecting the medication and fluids through the tube. At no time did Employee E4 administer fluids per gravity. In an interview on December 3, 2012, at approximately 2:00 p.m., the DON (Director of Nursing) stated that all fluids and medications are to be administered through syringe by gravity. The facility failed to follow the Standards of Nursing Practice for the Administration of Medications via tube feeding, and to adhere to the facility’s policy.
Based on staff interviews, clinical record review and observation, it was determined that the nursing home failed to ensure aseptic technique related to the wound care of two of 26 residents reviewed. Findings included the following: Review of Resident R74’s nursing admission record revealed that the resident was admitted to the facility after a surgical repair of a perforated esophagus and respiratory failure requiring a tracheostomy (surgery created airway located around the neck) and that the resident required isolation (the use of gloves, gown and face mask to prevent contamination) for a respiratory infection.
Resident R74’s periodic assessment revealed that the resident needed extensive assistance with care needs. In observation of Resident R74’s resident wound care on November 30, 2012, at 12:15 p.m. with Employee E1, a licensed nurse, it was revealed that the community treatment cart was placed outside of the room and a tube of Santyl, spray can of saline, to cleanse the wound was taken outside of the bag from the cart and placed on the resident’s bedside table for wound care. Employee E1 then uncapped the saline wound cleanser and placed the cap on the bed then proceeded to put it back into the container and also used the Santyl lube and tape. Employee E1 then gave the three items that were contaminated to another licensed nurse to place back into the community treatment cart, therefore contaminating the cart.