More dry itchy skin patches on body than a dozen impacted by scabies at va medical center

• at the time of our site visit, the medical center was in the process of conducting a dry itchy skin patches on body patient safety review because sterile processing ran out of supplies dry itchy skin patches on body to test the insulation of scopes used in laparoscopic or dry itchy skin patches on body endoscopic procedures. This testing is used to detect holes in the insulation dry itchy skin patches on body surrounding the scopes that may result in the transmission of dry itchy skin patches on body electrical current into surrounding tissues. If this occurs, patients may develop burns or latent infections. The medical center could not verify whether this testing had dry itchy skin patches on body been done on scopes used in approximately 20 procedures since dry itchy skin patches on body february 28, 2017-march 16, 2017.

• on march 29, 2017 a nurse emailed the patient safety manager, reporting that during an acute episode, she needed to provide oxygen to a patient. The floor was out of oxygen nasal cannulas (tubing that fits into a patient’s nose and provides oxygen). The nurse was able to use one found on the dry itchy skin patches on body crash cart, but reported the shortage as a risk to patient safety.

• on april 4, 2017 staff inspected the storeroom on the floor that had dry itchy skin patches on body run out of the oxygen nasal cannulas. Between 11 a.M. And noon, OIG staff determined the storeroom was out of alcohol pads; slipper socks/aqua shoes; denture cups (plastic containers used to store patients’ dentures); and large tegaderms, a type of wound dressing. OIG was informed that nursing staff inventoried the rooms three dry itchy skin patches on body times a day, and sent requests to logistics to replenish stock as needed. However, when OIG staff returned after 6 p.M. On the same day, only the alcohol pads had been replenished.

• on april 5, 2017 the lead sterile processing technician had been tasked with dry itchy skin patches on body finding a clip applier for use in a procedure scheduled dry itchy skin patches on body to occur the next day. A clip applier is a device that deploys surgical clips dry itchy skin patches on body that may be used to close off blood vessels or dry itchy skin patches on body other tubular structures. OIG staff accompanied the technician as she searched for the dry itchy skin patches on body device in the sterile processing department and in the central dry itchy skin patches on body supply room. Despite having the purchase order number for the device, she was unable to find it.

• on april 11, 2017 received an email stating that the operating room (OR) ran out of vascular patches, despite having requested the assistance of the deputy chief medical dry itchy skin patches on body officer of VISN 5 in obtaining them two weeks ago. The OR also ran out of doppler probes. Nursing staff stated that the ors could not form emergent dry itchy skin patches on body or elective open vascular surgery without those in stock.

• in june 2016, the medical center discovered that one of its surgeons used dry itchy skin patches on body expired surgical equipment on a patient during a surgical procedure. The medical center determined that the lack of an inventory dry itchy skin patches on body management program caused the error. Rather than undertake measures to implement an appropriate inventory program, the medical center elected to require its nursing staff to dry itchy skin patches on body conduct monthly rounds to identify and remove any expired supplies.

• on march 16, 2017, the facility found sterrad chemical indicator strips that expired on dry itchy skin patches on body february 28, 2017 in sterile processing. The indicators are placed with equipment and change colors when dry itchy skin patches on body exposed to hydrogen peroxide. This allows a visual verification that sterilization occurred. The medical center could not determine whether the expired indicators dry itchy skin patches on body had been used on some of the 396 items sterilized dry itchy skin patches on body in the medical center between the date of the strips’ expiration and the date staff discovered the expired strips and dry itchy skin patches on body removed them from the facility.

RELATED POSTS