Hickory Trail failed to Meet Conditions of Participation; Staffing levels were a repeated concern

The Centers for Medicare and Medicaid Services (CMS) determined that Hickory Trail Hospital did not meet the conditions of participation during a validation survey. The four conditions not met by the facility were Nursing Services, Food and Dietary Services, Infection Control, and Governing Body.

When reviewing Hickory Trail’s Nursing Services, CMS found “the facility failed to provide adequate and safe nursing services to its patients, as evidenced by the fact that there were expired medications found in an emergency kit, empty oxygen tanks found on units, and inadequate staffing levels for the provision of safe and effective care.”

The facility’s staffing policy specified minimum ratios of patients to staff, but records showed that units were short of staff on 12 days in the previous 13 day period. CMS wrote, “In an interview with the Director of Nurses on 3/6/12, it was acknowledged that the facility did not always meet staffing needs according to company policy.”

Meeting minutes from Hickory Trail’s Nursing Staffing Committee also showed that staffing concerns were brought up repeatedly in “Round Robin Issues with Staff” during the previous year, including the following notes:

[July 2011]

DS – Expressed concern about not having a 2nd nurse on A5 children’s unit when there are more than 14 patients. The ADON stated when there is no nurse available the supervisor will staff with an extra MHT to support the RN. Ultimately there will and should be 2 RNs and 2 MHTs. Also, she had concerns about the lack of flexibility of the grid to provide adequate staffing when acuity changes from unit to unit

CB – Concerned about the visitation policy. Not enough staff to accommodate visitation every day especially now since there needs to be an RN on the unit at all times.

[January 2012]

We currently do not have an acuity tool. We are at this time staffing based on numbers. At times the acuity on the units make it necessary to increase tech support. Supervisors consider reviewing the acuity of the patients on each unit from shift to shift and make appropriate adjustments. Current issues have been on Adult 1 where 1 nurse and 1 tech are not safely able to meet the needs of the patients. Reconsider adding a second tech to unit 1 when patient numbers are 9 or more.

CMS observed a “code blue” or possible cardiac emergency that coincidentally happened during the inspection. CMS found that “[d]uring the time of the code and its immediate aftermath, [a] nurse from the neighboring unit remained on the unit with the code, leaving the neighboring unit uncovered for the immediate availability of an RN to the patients on that (neighboring) unit.”

Additionally, CMS found that an Emergency Kit for two patient units contained an expired Epipen and two oxygen tanks that were empty. Another unit’s Emergency Kit also contained expired medications and an empty oxygen tank.

CMS also found that the facility had a contract with an Organ Procurement Organization (OPO), but “[r]eview of facility policies revealed that there were no associated policies written regarding notification of the OPO. There were no policies found regarding facility involvement with any Organ Procurement Organization.”

When CMS toured Hickory Trail to evaluate compliance with infection control requirements, the facility was found to have “failed to provide a safe and sanitary environment for its staff and patients.” Hickory Trail was found to be in violation of its own policies regarding laundry facilities, washing of patient clothing, dress code, the dietary department, and general policing of cleanliness. Observations of these areas included the following notes:

The floor was dirty with debris collected in corners and under shelving units. This demonstrated ineffective cleaning of the area.

An open, soiled (with brown, splattered material) container of 1cc allergy syringes was found stored on a shelf.

The agitator in 1 of 2 washing machines was full of odiferous mold and what appeared to be wet lint.

A large yellow sheet cake and a chocolate sheet cake were sitting on the sink ledge uncovered next to the soiled sink. The wall behind the cake was dirty with grime buildup.

As a result of this inspection, Hickory Trail Hospital was required to submit a Plan of Correction to address its deficiencies.