HospitalInspections.org

Based on review of facility documentation and medical records (MR), as well as employee interviews (EMP), it was determined that the facility failed to ensure compliance with the established policies requiring pharmacy review of medications for for three of three Emergency Department (ED) medical records reviewed. (MR1, MR7, and MR9).

Findings include:

Review of Facility Policy on November 6, 2018, at 1:40 PM "Patient Medication Order Department Name: Pharmacy Section Title Medication Distribution ... 02/2018 revealed, " ... Policy: ... The Department of Pharmacy is responsible for providing comprehensive pharmacy services according to applicable State and Federal law, professional licensure, and accepted standards of practice. The safe operation of the pharmacy is meant to promote rational use of medication in the hospital. ... Procedure: 1. Medications orders are entered electronically by the provider as per law. 2. Following entry, the medication order is reviewed by the pharmacist against the patient's profile for approved indication for use dosing accuracy, drug interactions, allergies, potential drug-drug and food-drug interactions, necessary laboratory values, therapeutic duplications and all other potential contraindications. Before verifying the order, for dispensing. ... Upon verification that the medication order is appropriate for the patient, the medication is prepared and dispensed. All medications are checked by a pharmacist before being dispensed. ..."

1. At approximately 12:30 PM on November 5, 2018, a review of MR1, revealed that the patient had presented to the ED on September 28, 2018. An ED note timed 13:06, revealed, "... DVT [Deep Vein Thrombosis] status post IVC filter [inferior vena cava filter] who was sent over for an outpatient ultrasound. Bilateral lower extremity shows a positive acute DVT right peritoneal vein and chronic DVT in the left lower extremity. ... I will discharge her home with a Xarelto starter pack ... Outpatient Medications: ... Phenobarbital ...Carbamazepine ..."

2. Review, at approximately 1:00 PM on November 5, 2018, of MR7, revealed that the patient presented to the ED on November 3, 2018. The patient to MR7 was administered a medication for pain and an antiemetic while in the ED. The patient was given a prescription for an antibiotic on discharge from the ED.

3. Review, at approximately 1:15 PM on November 5, 2018, of MR9, revealed that the patient presented to the ED on November 2, 2018. The patient to MR9 was administered intravenous antibiotics while in the ED. The patient was given an outpatient prescription for an antibiotic.

4. At approximately 12:30 PM on November 5, 2018, EMP4 confirmed that MR1, MR7, and MR9 were provided medications while in the Emergency Department.

5. During an interview at approximately 12:00 PM on November 5, 2018, EMP2 confirmed that the anticoagulant medication provided to MR1 in the ED, could be less effective or minimally effective due to the medication's interaction with Carbamazepine and Phenobarbital.

6. When asked, at approximately 2:00 PM on November 5, 2018, if medications given in the ED were reviewed by the pharmacy before administration, EMP2 indicated that the pharmacy staff does not have the time to complete profiles [review medications given in the ED against home medication for interactions, drug-drug and food-drug interactions] on all ED patients.