HospitalInspections.org

Based on interview and clinical record review, the facility failed to ensure Patient #24's care planning was updated to address amorous behaviors. The sample size was 30 patients, and the facility's census was 24 patients.

Findings:

The clinical record review for Patient #24 was completed on 12/16/10. The clinical record review revealed the 70-year-old patient was admitted to the facility on 11/09/10 with a diagnosis of dementia. The clinical record review revealed a history and physical dated 11/10/10 that stated the patient was admitted for an increase in combative behaviors and hostile attitude.

The clinical record review revealed a nursing note dated 11/11/10 at 6:00 A.M. that stated, "found (patient) in TV room kissing another (patient)."

The clinical record review did not reveal a plan of care that addressed the patient's amorous behavior following that episode.

The clinical record review revealed a nursing note dated 11/13/10 at 12:30 P.M. that stated, "Patient in dayroom kissing a female geriatric patient."

The clinical record review did not reveal a plan of care that addressed the patient's amorous behavior following that episode.

On 12/16/10 at 11:20 A.M. in an interview, Staff Z confirmed the care planning for the patient was not updated to address the patient's amorous behaviors.

Based on observation, interview, and review of websites of reference, the facility failed to ensure medications that are not to be crushed were not crushed prior to administration. This affected Patient #7 and Patient #10. The sample size was 30 patients, and the census was 24 patients.

Findings:

The clinical record review for Patient #10 was completed on 12/16/10. The clinical record review revealed the 62-year-old patient was admitted to the facility on 12/08/10 with a diagnosis of dementia and aggression. The clinical record review revealed the patient was ordered on 12/08/10 an extended release hypoglycemic agent to be taken twice a day.

On 12/14/10 at 8:40 A.M., the surveyor and Staff Y observed Staff X prepare medications for Patient #10. The surveyor observed the nurse to have crushed 11 different medications that included the extended release hypoglycemic agent (metformin extended release), a heart medication, three anti-hypertensive medications, and an anti-seizure medication. The surveyor and Staff Y then observed Staff X mix all the medications into a single, small soufflé cup with yogurt. The surveyor and Staff Y then observed Staff X administer the medications to the patient.

A review of the website drugs.com () was completed on 12/16/10. In regards to metformin extended release, the website stated, "Do not break, crush, or chew before swallowing."

The clinical record review for Patient #7 was completed on 12/16/10. The clinical record review revealed the 80-year-old patient was admitted to the facility on 12/10/10 with a diagnosis of dementia with behaviors. The clinical record review revealed the patient was ordered on 12/10/10 delayed release Depakote (an anti-seizure medication).

On 12/14/10 at 9:00 A.M., the surveyor and Staff Y observed Staff X prepare medications for Patient #7. The surveyor and Staff Y observed Staff X crush six medications that included the delayed release Depakote, aspirin, thyroid medication, and Exelon (a drug used to treat dementia). The surveyor and Staff Y then observed Staff X mix all the medications into a single, small soufflé cup with yogurt. The surveyor and Staff Y then observed Staff X administer the medications to the patient.

A review of the website at the U.S. National Library of Medicine National Institutes of Health at regarding delayed release Depakote was completed on 12/16/10. The review revealed the delayed release Depakote tablets are not to be split, chewed, or crushed.

On 12/14/10 at 12:05 P.M. in an interview, Staff A stated Staff X should not have crushed either the extended release metformin or the delayed release Depakote. He/she said Staff X should have contacted the pharmacist regarding the crushability of the medications, and/or contacted the physician to have a different route of administration ordered.

On 12/14/10 at 12:15 P.M. in an interview, Staff B stated Staff X should have given each medication in its own soufflé cup, rather than mix them all together.

Based on medical record review, staff interview, medical bylaw review, and policy review; the facility failed to ensure all verbal orders were authenticated within 48 hours for all patients. This affected Patient 1. Thirty medical records were reviewed.

Findings include:
The medical record for Patient 1 was reviewed on 12/13/10. The patient was admitted to the facility on 05/07/10 and expired on 05/08/10. The medical record contained admission orders and medication orders dated 05/07/10 at 5:30 PM that were noted as verbal orders. As of 12/15/10 at 4:30 PM, these verbal orders were not signed. This was verified with Staff C and Y at 4:30 PM on 12/15/10.

On 12/16/10, the medical staff bylaws were reviewed. The bylaws stated all verbal orders were to be signed within 24 hours by the physician.

On 12/16/10, the policy for Content/Requirements for Medical Records were reviewed. The policy stated verbal orders were to be signed by the prescribing physician within 24 hours.

Based on interview, policy review, and observation, the facility failed to ensure the pharmaceutical refrigerator did not contain expired medications. This affected all patients in the facility. The census was 24 patients.

Findings:

On 12/14/10 at 9:10 A.M., the surveyor and Staff Y inspected the contents of the medication refrigerator. The surveyor observed an opened vial of insulin dated as having expired on 12/04/10 and other dated as having expired on 12/05/10. The surveyor observed an opened vial of pneumonia vaccine without any date as to when it was opened or when it expires. The surveyor observed a note on each of the containers that held the medicines that stated the medications expire in 28 days after opening.

A review of the facility's policy entitled, "Nursing Unit Inspection Forms," and effective on May, 2010, was completed on 12/16/10. The review revealed multi-dose vials are to be discarded 28 days after opening.

On 12/14/10 at 9:15 A.M. Staff Y confirmed the medications had expired and the vaccine was undated.

Based upon observations during the Life Safety Code tour of the hospital on December 13, 2010 through December 15, 2010 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:

Please refer to A 710.

1. Door in hazardous area not latching properly
2. Locks on seclusion rooms not operating properly
3. Documentation for emergency battery operated lights not available
4. Smoke detectors testing documentation not available and smoke detectors not mounted according to regulations
5. Medical gas E tanks not secured properly

Based upon observations during the Life Safety Code tour of the hospital on December 13, 2010 through December 15, 2010 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:

Refer to the Life Safety Code Survey Report Form.

Deficiencies were issued at K-29 (Door in hazardous area not latching properly), K-43 (Locks on seclusion rooms not operating properly), K-46 (Documentation for emergency battery operated lights not available), K-54 (Smoke detectors testing documentation not available and smoke detectors not mounted according to regulations), and K-76 (Medical gas E tanks not secured properly).