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Based upon observations during the Life Safety Code tour of the critical access hospital on January 3, 2011 through January 4, 2011 and interview with staff, the hospital did not meet all the requirements of the 2000 Life Safety Code of the National Fire Protection Association.

Findings include:

A deficiency was issued at K45 as the facility failed to arrange illumination at the exit discharge so as to ensure that failure of any single lighting fixture will not leave the area in darkness.

Refer to the Life Safety Code Survey Report Form at K45.

Based on review of the facility's reference material, interview, and clinical record review, the facility failed to ensure Patient #22's response to an intravenously administered heart medication was monitored and documented. The sample size was 32 patients, and the census was 11 patients.

Findings:

The clinical record review for Patient #22 was completed on 01/06/11. The review revealed the 66-year-old patient presented to the emergency room on 01/02/11 at 10:55 P.M. The clinical record review revealed an emergency room report, dictated on 01/03/11, that stated the patient had a chief complaint of palpitations and stated the patient was diagnosed with persistent atrial fibrillation.

The clinical record review revealed the nurse began cardiac monitoring of the patient; however, the rhythm strip, present in the medical record, did not have either a date or time.

The clinical record review revealed the physician ordered and the nurse began, a cardiazem bolus at 11:45 P.M. and after the bolus, a cardiazem drip. The clinical record review revealed the patient's blood pressure reading was 75 millimeters mercury/47 millimeters mercury at 1:13 A.M. The clinical record review revealed an intravenous therapy sheet that stated on 01/03/11 at 2:13 A.M., the nurse stopped the cardiazem drip due to a decrease in blood pressure. The clinical record review did not show what the patient's blood pressure reading was and did not reveal any other blood pressures readings obtained since 1:13 A.M. The clinical record review did not indicate any rhythm strips were obtained after the cardiazem drip was stopped. The clinical record review did not reveal how much cardiazem had been administered.

The clinical record review revealed an emergency room report, dictated 01/03/11, that stated the patient was "persistently in and out of atrial fibrillation."

The clinical record review revealed the patient was transferred to a different facility on 01/03/11 at 2:40 A.M.

A review of the facility's book of reference entitled, "Charting Made Incredibly Easy", copyright 1998 by Springhouse Corporation, stated to monitor the patient's response to specific treatments such as medication administration.

On 01/05/11 at 3:30 P.M. in an interview, Staff D confirmed there was no other documentation of blood pressure readings to be found after the documentation on 01/05/11 at 1:13 A.M., confirmed the cardiazem drip was stopped at 2:13 A.M., confirmed the clinical record did not contain the amount of cardiazem administered, and confirmed the clinical record did not contain a rhythm strip or documentation the patient's blood pressure reading was obtained prior to the patients transfer.

Based on observation and interview, the critical access hospital failed to maintain its distinct part acute rehabilitation beds separate from its other patient population beds. This has the potential to affect any future patients needing acute rehabilitation.

Findings:

On 01/05/11 at 12:45 P.M., the surveyor toured the distinct part, acute rehabilitation area of the critical access hospital with Staff C. During the tour, Staff C explained in an interview that patient rooms 118, 120, 121, 122, 123, 125, and 127 were the distinct part acute rehabilitation beds. The surveyor observed these rooms to be located contiguously near each other. During the tour, the surveyor observed a patient in rooms 122, 120, 118, 123, 127. Staff C confirmed there were patients in these rooms. Staff C stated in an interview that the acute rehabilitation beds are used for other patients as the need arises. He/she said an example of such a need is when the nursing staff want a patient located close to the nursing station for close monitoring.