Tuesday, October 31, 2017

Hospital Cited For CPR on DNR Patient

By Walter F. Roche Jr.

An Allegheny County hospital has been cited by the Pennsylvania health officials for initiating resuscitation on a patient who had completed an advanced directive stating his desire not to have that happen.
The incident occurred in mid-July at the 328-bed St. Clair Hospital in Pittsburgh.
According to the recently released inspection report from the state Health Department, the unnamed male patient was brought to the hospital on July 17 from a personal care home. Hospital staff later verified that he was on hospice care at that facility, according to the report.
Several hours later the patient was found unresponsive and cardio pulmonary resuscitation was initiated, inspectors reported following an Aug. 14-15 visit to the hospital.
"The patient has the right to formulate advance directives and to have hospital staff and practitioners who provide care in the hospital comply with these directives," the report states.
The report does not include any information on the results of the resuscitation efforts.
In response to questions about the report a hospital spokesman said that the facility had self reported the incident to the state.
"St. Clair Hospital recently reported to the Pennsylvania Health Department an event in which a patient transferred from a personal care home was resuscitated despite having earlier filed a "do not resuscitate" code status," the spokesman said.
He added that a plan of correction had been filed with the state and approved. It is now being implemented, according to the statement.
The plan calls for a series of training sessions for staffers with subsequent audits to ensure that directives are being followed. The hospital will also notify operators of personal care homes and assisted living facilities that send patients to St. Clair of its policies regarding advance patient directives.
Under the plan a patient's advance care directives will be entered on his or her record upon admission.
"The appropriate code status designation will be entered into the patient's medical record upon admission," the report states.
"This event underscore St. Clair Hospital's objective to ensure accurate communication regarding patient wishes about end-of-life care," the hospital statement continued.
In addition to the failure to follow a patient's directives, St. Clair was cited for failing to administer written orders of a practitioner and failure to ensure that cardiac monitoring equipment was functioning properly. A cardiac monitor had been ordered for the patient but the first reading was recorded only after he was found unresponsive, inspectors reported.
In response St. Clair said it would implement a plan to increase cardiac monitoring and to train staff on how to use the equipment.
Contact: wfrochejr999@gmail.com

Sunday, October 22, 2017

Admissions Frozen at Privatized Metro Facility

By Walter F. Roche Jr.

Citing violations of state and federal laws and regulations state health officials have ordered a freeze on admissions at the Nashville nursing home which Metro Nashville officials privatized and turned over to a private for profit company three years ago.
The order issued late last week by state Health Commissioner John Dreyzehner also imposed fines totaling $7,500 on the facility now known as Nashville Community Care and Rehabilitation at Bordeaux.
Under an agreement with Metro operation of the 419 bed was turned over to Signature Health Care, a chain of nursing homes, which has been cited by the state for deficiencies at its other facilities.
Dreyzehner said a special monitor was also appointed to oversee operations of the facility at 1414 County Hospital Road.
The freeze was imposed based on a complaint survey conducted by state health inspectors from Sept. 24 to Sept. 27.
According to the commissioner, violations uncovered related to the administration of the facility and and patient rights.
The notice, effective Oct. 19, bars the facility from admitting any new patients until further notice. The nursing home is required to post a copy of the order at its main public entrance "where it can be plainly seen."
The nursing home can appeal the findings and the two fines of $5,000 and $2,500 to a state board.
In announcing the freeze Dreyzehner cited a state law that authorizes the commissioner to suspend admissions "when conditions are determined to be, or are likely to be, detrimental to the health, safety and welfare of the residents."
Metro's agreement with Signature privatizing the Bordeaux facility has not been without controversy in part based on the amount of money the city is committed to provide to help underwrite its losses.
The initial lease was signed in 2014 and was renewed for another four years in 2016.
Another Signature facility, Signature Health Care at Saint Francis in Memphis was cited by the state in March for multiple violations of state and federal regulations. As a result the nursing home had its Medicare agreement terminated and the agency ceased any further payments.

Thursday, October 19, 2017

Highly Critical Einstein Report Pulled Back

By Walter F. Roche Jr.

A highly critical inspection report on the Albert Einstein Medical Center has been taken of the Pennsylvania Health Department web site and an agency official says it had been posted prematurely.
The report, which was posted in early August, cited the 701 bed facility for failing to adequately investigate four unexpected patient deaths.
The report also charged that Einstein refused to allow state surveyors to interview key staffers and examine records.
Einstein declined comment when first contacted by this blog prior to the posting of a report on the report in early August.
April Hutcheson, spokeswoman for the state Health Department said the report had been posted "inadvertently. It was not complete. It will be posted 41 days after is complete."'
 Although that report was based on a May visit to Einstein by state inspectors, the state has posted a subsequent Einstein report based on a visit in August. In addition the now withdrawn report was based on cases dating back to 2016.
The withdrawn report cited Einstein for failure to comply with state and federal requirements in serious cases "involving the clinical care of a patient that results in death or compromises patient safety."
The report included a plan of correction filed by Einstein in which they promised to institute new patient safety protocols and to use those new standards for all serious events beginning on July 1.
The hospital, however, repeated the assertion that some of the records sought by state inspectors at the time of the inspection are "peer review, protected, privileged documents, entitled to protection under federal and state law."
The first case cited was of a patient who was admitted in July of 2016 was found looking pale and unresponsive on Aug. 7, 2016. Records examined by the surveyors attributed the death to "excessive sedative use leading to hypo-ventilation and brain anoxia."
The second case involved an unidentified patient who underwent a colonoscopy on Sept. 23, 2016 only to return "with worsening abdominal pain." The report states.
The patient, who had apparently suffered a colon rupture, did not survive. The report states the patient had gone home the same day as the procedure against medical advice.
In the third case a patient reported to the emergency room on June 21, 2016 with "agitation and psychiatric symptoms."
When the patient asked for something to eat a sandwich was provided. The patient was choking by the time the nurse returned. The patient subsequently expired.
State inspectors asked for records showing required reviews were performed following the death. "None were provided," the inspection report stated.
Another death occurred following an esophageal intubation in February. When state surveyors asked for documentation and the results of a "root cause analysis," they were told the documents were confidential and "protected."
In addition, the report states, that no completion dates were included for "action items" set to be implemented as a result of the incidents.
Cited in the report was a requirement by licensed health facilities to "track medical errors and adverse patient events, analyze their causes and implement preventive actions and mechanisms."
Contact: wfrochejr999@gmail.com