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Based on interview and record review, the facility filed to ensure one sampled patient, Patient 28, received the document, "An Important Message From Medicare About Your Rights." This failure may impact the patients right to appeal his discharge date from the facility, which potentially may impact his overall medical stability.

Findings:

A review of Patient 28's record was conducted. Patient 28 was admitted to the facility on April 4, 2015, with a diagnosis of pneumonia and end stage chronic obstructive pulmonary disease.

A further review of Patient 28's record failed to show that the patient received the document, "An Important Message From Medicare About Your Rights."

An interview was conducted with the Nursing Supervisor on May 12, 2015, at 4 p.m., who stated after reviewing Patient 28's record that the document, "An Important Message From Medicare About Your Rights," was not given to Patient 28 or the patients' responsible party.

A review of the facility policy, "Patient Rights and Responsibilities (MEC Approval 4/2014)," was conducted. The policy indicates, "The facility supports and upholds the promotion and protection of patient rights whether services to patients are provided on an inpatient or outpatient basis. The concept of the patient as a partner is important when: informing patients about their rights, helping patients understand and exercise their rights."

Based on interview and record review, the facility failed to ensure an assessment of one sampled patient's skin status, Patient 28, was implemented prior to the patient's transfer to a skilled nursing facility. This failure increased the potential for a lack of ongoing care and treatment of a potentially serious, undiagnosed pressure ulcer (localized areas of tissue necrosis that develop when soft tissue is compressed between a bony prominence and an external surface for long periods of time).

Findings:

A review of Patient 28's record was conducted. Patient 28 was admitted to the facility on April 4, 2015, with a diagnosis of pneumonia and end stage chronic obstructive pulmonary disease.

A review of the nursing narrative dated April 4, 2015, at 7:06 p.m., upon admission, indicated Patient 28 had no open wounds noted.

On April 10, 2015, (time not clearly indicated), a picture was taken of Patient 28's lower back/coccyx. A pressure ulcer was present in the picture.

A further record review failed to show an assessment of the pressure ulcer located on the left side of Patient 28's lower back/coccyx area was conducted.

An interview was conducted with the Nursing Supervisor (NS) on May 12, 2015, at 5 p.m. The NS stated after reviewing Patient 28's record, it appeared the patient had a pressure ulcer to his lower back on April 10, 2015.

The NS further stated an assessment of Patient 28's skin status was not implemented prior to the patients transfer, to reflect the current status and the ongoing care needs of the pressure ulcer.

A review of the facility policy, "Decubitus Ulcer (Pressure Ulcer), Assessment, Prevention, Treatment, Management (MEC Approval Date 4/2014)," was conducted. The policy indicates, "It is the policy of the hospital to provide a skin assessment on admission and on a daily basis on all patients admitted to the hospital...Photos must be labeled with...stage in cm (centimeters, width x length), depth, presence or absence of drainage, odor, color and the licensed nurse signature."

Based on interview and record review, the facility failed to ensure for six sampled patients, (Patients 14, 25, 26, 27, 28 and 30), pain assessments were conducted consistently prior to and after pain medication was administered. This failure could potentially lead to inadequate pain management and impact the healthcare of the patients.

Findings:

A review of the facility policy, "Pain Management (MEC Approval Date 3/2014)," was conducted. The policy indicated, It is the policy of the facility to assure that pain is assessed and treated promptly, effectively, and for as long as pain persists...A pain scale from 1-10 is utilized by the facility to evaluate pain in adult patients...Pain relief should be evaluated a minimum of 30 minutes after parenteral injections (intramuscular injections) and 60 minutes after oral medications."

a. A review of Patient 14's record was conducted. Patient 14 was admitted to the facility on April 5, 2015, with a diagnosis of a hemorrhage following a motor vehicle accident. Patient 14 received Toradol 30 milligrams (mg) intravenously for complaints of pain. On April 5, 6, and 7, 2015, the patient received Toradol twice each day. The pain assessments were not conducted within the guidelines established by the facility's policy and procedure.

b. A review of Patient 25's record was conducted. Patient 25 was admitted to the facility on April 3, 2015, with a diagnosis of bowel perforation. Patient 25 received Morphine 2 mg (a narcotic) intramuscular (IM) injections for pain relief. On April 4 and 7, 2015, the pain assessments were not conducted within the guidelines established by the facility's policy and procedure.

c. A review of Patient 26's record was conducted. Patient 26 was admitted to the facility on April 10, 2015, after a prior surgical incision ruptured, requiring another surgical intervention. Patient 26 was receiving Demerol (narcotic)100mg. IM for pain relief. On April 13, 2015, April 14, 2015 and on April 16, 2015, the pain assessments were not conducted within the guidelines established by the facility's policy and procedure.

d. A review of Patient 27's record was conducted. Patient 27 was admitted to the facility on May 8, 2015, with a diagnosis of appendicitis. The patient subsequently had surgical removal of the appendix.

On May 10, 2015, Patient 27 received Percocet 10 mg/325mg orally (narcotic) for pain relief. The medication administration record indicated the patient's pain prior to receiving the medication was a level "9," the record did not indicate the pain level following the administration of the medication.

e. A review of Patient 28's record was conducted. Patient 28 was admitted to the facility on April 4, 2015, with a diagnosis of pneumonia and end stage chronic obstructive pulmonary disease.

Patient 28 had an order to receive Tramadol (pain medication) QID (four times daily). Patient 28 received Tramadol orally from April 4, 2015, through April 10, 2015. The patient did not receive an assessment for pain before or after the administration of these medications during the seven days the patient was hospitalized.

f. A review of Patient 30's record was conducted. Patient 30 was admitted to the facility with a diagnosis of pregnancy. The patient subsequently had a caesarian section and a tubal ligation. The patient received Toradol 30mg IM twice on March 26, 2015, and once on March 27, 2015. The pain assessments did not follow the facility's policy and procedure.

On March 27, 2015, Patient 30 received Toradol 30 mg IM. The pain assessment did not follow the facility's policy and procedure.


On March 28, 2015, Patient 30 received Percocet 5mg/325mg orally. The pain assessment did not follow the facility's policy and procedure.

An interview was conducted with the Chief Nursing Officer (CNO) on May 12, 2015, at 2 p.m. The CNO stated the assessments of these patients' pain prior to and after the administration of pain medication was not implemented on a consistent basis.