Desert Valley Hospital -Septicemia

8/4/2019 Desert Valley Hospital -Septicemia

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A. BUILDING

(X1) PROVIDER/SUPPLIER/CLIA

IDENTIFICATION NUMBER:

STATEMENT OF DEFICIENCIES

AND PLAN OF CORRECTION

(X3) DATE SURVEY

COMPLETED

PRINTED: 09/16/20

FORM APPROV

(X2) MULTIPLE CONSTRUCTION

B. WING _____________________________

______________________

California Department of Public Health

CA240001330 02/15/2011

C

VICTORVILLE, CA 92395

STREET ADDRESS, CITY, STATE, ZIP CODENAME OF PROVIDER OR SUPPLIER

DESERT VALLEY HOSPITAL16850 BEAR VALLEY RD

PROVIDER'S PLAN OF CORRECTION

(EACH CORRECTIVE ACTION SHOULD BE

CROSS-REFERENCED TO THE APPROPRIATE

DEFICIENCY)

(X5)

COMPLET

DATE

IDPREFIX

TAG

(X4) IDPREFIX

TAG

SUMMARY STATEMENT OF DEFICIENCIES

(EACH DEFICIENCY MUST BE PRECEDED BY FULL

REGULATORY OR LSC IDENTIFYING INFORMATION)

A 000 Comment A 000

AMENDED AND CORRECTED

The following represents the findings of the

Department of Public Health during a complaint

investigation conducted on 2/14/11 - 2/15/11.

Complaint: CA00258500

Representing the Department:

16501, Nurse Consultant

26881, Medical Consultant

A 036 HSC 1288.6(b) Health & Safety Code 1288.6

Each general acute care hospital that uses

central venous catheters (CVCs) shall implement

policies and procedures to prevent occurrences

of health care associated infection, as

recommended by the Centers for Disease Control

and Prevention intravascular bloodstream

infection guidelines or other evidence-based

national guidelines, as recommended by the

advisory committee. A general acute care

hospital that uses CVCs shall internally report

CVC associated blood stream infection rates in

intensive care units, utilizing device days to

calculate the rate for each type of intensive care

unit, to the appropriate medical staff committee of

the hospital on a regular basis.

This Statute is not met as evidenced by:

A 036

Based on observation, interview, and document

review, the hospital failed to ensure their policiesand procedures were implemented that prevent

occurrences of health care associated

bloodstream infections.

censing and Certification Division

ABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE (X6) DATE

If continuation sheet 16899TATE FORM YSO811



A. BUILDING





(X3) DATE SURVEY

COMPLETED

PRINTED: 09/16/20

FORM APPROV


B. WING _____________________________

______________________


CA240001330 02/15/2011

C







DEFICIENCY)

(X5)

COMPLET

DATE

IDPREFIX

TAG

(X4) IDPREFIX

TAG




A 036Continued From page 1A 036

Findings:

On 2/14/11 at 8:30 am, a tour was conducted of

the intensive care unit. During the tour it was

noted that Patient 1 had a central venous

catheter.

During a concurrent interview, Administrative

Staff B confirmed that Patient 1 had a peripherallyinserted central venous catheter.

On 2/14/11 at 8:35 am, Patient 1's medical record

was reviewed. Documentation in the medical

record showed that the patient was admitted to

the hospital on 2/4/11. Documentation in the

medical record also showed that on 2/7/11 at

6:11 pm, the patient had a central venous

catheter inserted.

During a concurrent interview, Administrator B

stated that it was hospital practice for nursing

staff to complete the form titled, "Central line

adherence monitoring," and insert the form in the

patient's chart. Administrative Staff B stated that

the physician was to initially sign the form.

Administrative Staff B stated that physician

needed to initial the form, every day the central

line was utilized.

A request was made to review Patient 1's,

"Central line adherence monitoring" form. The

form was located in Patient 1's medical record

and revealed that besides having a patient

identifying label, the form was blank. The date of

insertion, and line days (each day the central line

is used) were blank. It was also noted that thephysician did not sign or initial each day the

central line was utilized.

During a concurrent interview, Administrative





A. BUILDING





(X3) DATE SURVEY

COMPLETED

PRINTED: 09/16/20

FORM APPROV


B. WING _____________________________

______________________


CA240001330 02/15/2011

C







DEFICIENCY)

(X5)

COMPLET

DATE

IDPREFIX

TAG

(X4) IDPREFIX

TAG




A 036Continued From page 2A 036

Staff B, confirmed that nursing staff and the

physician failed to ensure that the central line

monitoring form was completed each day.

On 2/14/11 at 11 am, the hospital's 11/08, policy

and procedure titled, "IV Catheter - central

venous" was reviewed. The policy and procedure

provided no direction as to who was responsible

for completing each sections of the formmonitoring form. In addition, the policy and

procedure gave no direction as to who was

responsible for determining the daily medical

central line necessity.

Failure to monitor and remove central venous

catheters as soon as possible, increases the

patient's risk of developing a bloodstream

infection related to central venous catheter use.



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Desert Valley Hospital -Septicemia