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TENNOVA HEALTHCARE-CLARKSVILLE
STAFFING AND DELIVERY OF CARE
Tag No.: A0392
Based on hospital policy, medical record review and interview, the hospital failed to ensure medications ordered by the physican were administered timely by emergency department nursing staff for 1 of 3 (Patient#1) patient records reviewed.
The findings included:
1. Review of the hospital policy, "Standard Times of Mediation Administration" revealed, "...Medications will be administered at specific administration times outlined below...STAT-Immediately...medication will be sent within 15 minutes of pharmacy receipt of order..."
2. Medical record review revealed Patient #1 presented to the Emergency Department (ED) on 4/27/2020 at 11:51 AM with complaint of a migraine headache with nausea and vomiting. Patient #1 was triaged by an Registered Nurse (RN) at 11:54 AM and assessed as a Priority 2 level patient. Patient #1 received a medical screening exam at 12:10 PM. The physican ordered the following medications at 12:10 PM: diphenhydramine 25 milligrams (mg)/ 0.5 milliliters (mL) intravenous- STAT and metoclopramide 10 mg/ 2 mL IV- STAT.
Patient #1 did not receive the medication ordered by the physican. At 1:05 PM, when the ED physican returned to the room, Patient #1 stated she wanted to be discharged so she could seek care at another facility.
3. During an interview on 1/19/2021 at 12:10 PM, the ED Nursing Director stated a STAT medication in the ED should be given within 30 minutes. She further stated that 30 minutes for a STAT medication delivery was a standard of care for emergency medicine nurses. When asked if there was a specific policy, she began looking in the hospital's online policy system and located the Standard Times of Medication Administration policy referenced above. She then stated that 15 minutes for STAT drugs would be across the entire hospital system, including her ED. She verified the medications ordered for Patient #1 were most likely in the ED and did not have to be sent over from the pharmacy She verified the nursing staff failed to administer Patient #1's medications in accordance with physican orders.