Fairview Care Center Of Bethlehem Pike (December 4th)

Based on the review of the Professional Nurse Practice Act, clinical records, facility policies and procedures and interviews with staff, it was determined that the nursing home failed to adhere to the Standards of Nursing Practice for enteral medication administration for one of 27 residents. The findings included the following: The Pennsylvania Code, Professional and Vocational standards, which states that a registered nurse is responsible for carrying out nursing care which promotes, maintains and restores the well-being of individuals and is responsible for all actions as a licensed nurse and is accountable for the quality of care delivered. Code 21:145 states that a licensed practical nurse has the necessary knowledge, preparation, experience and the competency to properly execute the practice, document and maintain accurate records. On November 3, 2012, at approximately 1:30 p.m., Employee E4 was observed administering medication used to treat an undisclosed medical condition by administering 25 milligrams of a medication that was ordered by the physician at 1:30 p.m.

Employee E4 immediately withdrew 50cc of water into a syringe and injected the solution into the tube without placing the stethoscope over the resident’s over the resident’s epigastric region to determine if sounds could be heard to determine the proper placement of the tube. Employee E4 also failed to check for residual by aspirating the stomach contents to determine the amount of residual before introducing additional fluids to 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 stated that all fluids and medications are to be administered through the syringe by gravity.

Based on observation, staff interviews and clinical record review, it was determined that the nursing home failed to ensure aseptic technique related to wound care for two of 26 residents reviewed. Those findings included the following: In review of Resident R74’s nursing admission it was revealed that the resident was admitted to the facility after a surgical repair of a perforated esophagus and respiratory failure requiring a tracheostomy and that he resident required contact isolation for a respiratory infection, MRSA. Resident R74’s periodic assessment revealed that the resident needed extensive assistance with care needs. In observation of Resident R74’s wound care on November 30, 2012 at 12:15 p.m. with Employee E1, a licensed nurse, revealed that the community treatment cart was placed outside the room and a tube of Santyl, spray can of saline to cleanse the wound and tape was taken out of a plastic 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 back on the container and also used the santyl tube and tape then gave the three items that were contaminated to another licensed nurse to place back to the community treatment cart, therefore contaminated the cart.