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Based on observation, interview and record review the facility failed to follow their policy's and procedures regarding patients with medication allergies or pain. In two out of eleven patients (#1 & #3) with medication allergies, no red arm bands were applied, resulting in the potential for medication error in patients that have known medication allergies. In three out of fourteen patients ( #5, #9, & #13), pain management steps were not followed , initial pain assessment not done (#9 & #13) and pain reassessment was not done in a timely manner (#5) resulting in the potential for inadequate pain control.

Findings include:

During tour of the Emergency Department (ED) on 9/20/12 beginning at 0930 (9:30 am) eleven (11) patients were interviewed and asked about known medication allergies. 2 of the 11 verbalized medication allergies (#1 penicillin, & #3 codeine) but did not have on a red arm band. At 0950 (9:50 am) interview of staff #C stated 'I do not know why they do not have on red arm bands, that is done in triage during the initial assessment".

Review of policy and procedure titled "Allergies, Safeguarding Patients with Allergies" dated revised 5/11 from the Clinical RN Manual states " Steps in Procedure ..B....#3. Apply red allergy band if patient has allergies. Please refer to medical record for listing of allergies with allergic response."

On 9/20/12 at approximately 1300 (1:00 pm) during records review of fourteen(14) ED patients including 3 closed records revealed: patient #5 admitted with chest pain 9/19/12 at 2327 (11:27 pm) level of 8 has no documented reassessment again until 0653 (6:30 am) 9/20/12. Interview of staff Q on 9/20/12 at approximately 1530 (3:30 pm) " that is a long time between assessments for chest pain". Patient # 9 has no documented pain assessment in the initial triage assessment 9/19/12 at 1724 (5:24 pm) & patient #13 has no pain assessment documented on the triage note 9/8/12 at 2144 (9:44 pm) Interview of staff #M, #N, &Q on 9/20/12 at approximately 1500 (3:00 pm) stated "we cannot find the pain assessment on patient #9 & #13 and no further documentation on the chest pain of patient #5.

Review of policy and procedures titled "Pain Management" last revised 3/11 page 2 of 3 and "Patient Assessment" last revised 3/12 page 3 of 12 contain the same detailed list "Assessment of pain will be documented 1. On admission 2. After any known pain producing event 3. with each new report of pain 4. Routinely at regular intervals 5. After each pain management intervention within one hour.