HospitalInspections.org

Based on findings from facility document review, the facility's policy and procedure (P&P) addressing pain management did not provide guidance that will ensure nursing staff reassess patients for effectiveness of pain interventions in a timely manner.

Findings include:

--Per review of the facility's P&P titled "PAIN EVALUATION," effective 7/2011, it contained the following statements: "Effectiveness of pain management interventions will be evaluated according to methods of pain management used and/or route of administration. Re-evaluation intervals will vary in accordance with the method of intervention (i.e. positioning vs. medicating with oral vs. IV routes)." The P&P lacked specific guidance on minimum timeframes for pain reassessments following the various interventions noted (e.g., following administration of oral medications, following administration of intravenous medications, etc.).

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Based on findings from observation, interview, and facility document review, the facility did not provide pharmaceutical services in accordance with current standards of professional practice. Specifically, an opened multi-dose insulin medication vial was not labeled with the date opened, 5 of 5 nursing staff interviewed believed that opened multi-dose medication vials are acceptable for use for 30 days (versus the generally accepted standard of 28 days), and the hospital policy and procedure (P&P) in this latter issue was not accurate.

Findings include:

--Per observation on 3/9/15 at 10:45 am, one (1) opened 10 milliliter (ml) vial of Levemir (a long acting insulin) in the medication cart in the Cardiothoracic Intensive Care Unit was not labeled with an expiration date.

The above was acknowledged with Registered Nurse (RN) #5 at the time of observation.

--During interviews with five nursing staff on 3/9/15 at 10:45 am, 11:15 am, 11:30 am, 2:00 pm, and 3:10 pm, RNs #5, #1, #2, #3, and #4 respectively, they each indicated opened multi-dose medication vials of insulin could be available for patient use for up to 30 days after the vial was opened.

--The facility's policy and procedure (P&P) titled "MEDICATIONS DISTRIBUTED WITH REDUCED EXPIRATION DATES," last revised 1/30/06, contained the statement "All insulin products are to be labeled with a one-month expiration date at the time of issuance." The P&P lacked guidelines specifically acknowledging the 28 days expiration per generally accepted standards for pharmaceutical services, and directing staff to discard an opened multi-dose vial of insulin after 28 days.

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Based on findings from document review and interview, facility staff did not follow generally accepted standards of infection control in connection with use of multi-dose medication vials for more than one patient. Pertinent hospital policies and procedures (P&Ps) lacked guidance in this matter.

Findings include:

--During interviews with three nursing staff on 3/9/15 at 2:00 pm, 1:55 pm, and 3:30 pm, Registered Nurses (RN) #3, #6, and #7 respectively, each indicated multi-dose medication vials are brought into a patient's room to draw up medication at the patient's bedside.

--Per review of the facility's P&Ps titled "Medication Administration," effective 1/2014, and "Handling Medications," effective 11/2012, both lacked guidance on the use of multi-dose medication vials for more than one patient. They lacked indication that multi-dose medication vials should not be taken into a patient's room.