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Based on medical record review, Pharmacy information review, facility policy review, and interview, the facility failed to ensure medications were administered according to the Physician's Order for one patient (#15) of nineteen patients reviewed.

The findings included:

Patient # 15 was admitted to the facility on April 9, 2011 to the 2200 hall with diagnoses to include Cardiac Catheterization with Angio Seal, Coronary Artery Disease, Narcolepsy, Sleep Apnea, Hypertension, Atrial Fibrillation, and Morbid Obesity.

Medical record review of the Physician's Orders, dated April 9, 2011 at 12:50 p.m., revealed " ...Provigil (Stimulant utilized to prevent sleep related to Narcolepsy) 200 mg (milligrams) Q (every) d (day) ..." Medical record review of the Medication Administration Record (MAR), dated April 9, 10, 11, and 12, 2011 revealed " ...Provigil 200 mg Qd 10:00 a.m. ..." Continued medical record review of the MAR revealed the Provigil was dispensed at the following times: April 9 - 4:29 p.m.; April 10 - 1:27 p.m.; April 11 - 2:57 p.m.; and April 12 2:09 p.m., "not administered ...patient not sleeping ...M.D. (Medical Doctor) notified and D/C'd (discontinued) ..."

Review of the pharmacy provided print out " ...Merck Manuals online medical library ...Modafinil (generic name for Provigil) ..." on Provigil confirmed " ...Narcolepsy ...200 mg as a single daily dose in the morning ..."

Review of the facility policy Medication Dosing Schedule, policy number PS-600-028, revised May 27, 2010, revealed " ...to define the medication dosing schedule ...Medications will be dispensed from Pharmacy Services in accordance with the appropriate timing of the dosing schedule ...Medication orders which require "STAT" or "NOW" doses may be given outside the standard dosing schedule ..."

Review of the facility policy Administration and Documentation of Medication, policy number PC-600-002, revised March 19, 2009, revealed " ...to develop guidelines for the administration of medication ...Unless ordered "STAT" or "NOW", routinely scheduled medications are to be initiated within 2 hours of transcribing order. In order to prevent the patient from receiving excess medication, previous medications taken should be reviewed prior to medicine being given ...If there is any question about medications, the nurse shall consult a reference book located on the zone, pharmacist. Microdex, or Lexi-Comp Database on the automated dispensing cabinet ...Whenever possible, patients and caregivers shall be instructed on the medication and what the medication is prior to administration ...Routine Scheduled Medication: ...The nurse shall check to determine the times medications and treatments are to be given ...Regularly scheduled medication may be administered up to one hour before the scheduled time or up to one hour after the scheduled time unless the time of the administration is critical ..."

Interview with the pharmacist at the 2200 hall nurse's station on April 13, 2011 at 10:00 a.m., confirmed the Provigil was to be administered in the mornings as the medication was a stimulant and would prevent sleep and the MAR indicated the medication was to be administered at 10:00 a.m..

Interview at the 2200 hall nurse's station on April 13, 2011 at 9:50 a.m., with the RN Shift Leader and the Clinical Integration Officer confirmed medications to be given on a daily basis were to be administered at 10:00 a.m. unless otherwise specified in the Physician's Order; and the Physician's Order had not been followed.

C/O #27813

Based on observation, facility policy review, and interview, the facility failed to ensure infection control practices were maintained on two medical surgical halls (2200 and 4500) of seven halls reviewed.

The findings included:

Observation with the Registered Nurse (RN) Shift Leader and Clinical Integration Officer on the 2200 hall on April 13, 2011 at 8:45 a.m., revealed, in the supply cabinet located outside the occupied patient room #2203, paper chart supplies were lying on top of suction supplies and Personal Protective Equipment (PPE). Continued observation revealed at 8:50 a.m., two Patient Care Assistants (PCA) entered room #2203 without washing or sanitizing the hands; touched items in the patient room; and without washing or sanitizing the hands exited the room and proceeded down the hall. Continued observation revealed at 8:55 a.m., the supply cabinet located outside the occupied patient room #2215 contained paper products for the patient bathroom to include toilet paper and paper towels with a heavy build-up of dust and debris on the shelf containing the paper products.

Interview with the RN Shift Leader and Clinical Integration Officer on the 2200 hall on April 13, 2011 at 8:45 a.m., confirmed paper chart supplies are not to be stored with patient supplies; staff are to wash or sanitize the hands before and after contact with patients or patient items; and patient supply cabinets are to be free of dust build-up and debris.

Observation on the 4500 hall where Oncology patients were roomed on April 13, 2011 at 1:20 p.m., revealed RN #1 rolled a medication cart into room 4516; touched patient items in the room; touched the top of the medication cart; scanned the barcode on the patient wrist band; and without wiping down the medication cart or the barcode scanner, exited the room with the medication cart.

Interview in the hallway outside the patient room with RN #1 on April 13, 2011 at 1:20 p.m., confirmed the cart and barcode scanner were not cleaned prior to exiting the patient room.

Observation on the 4700 hall where Oncology patients were roomed on April 13, 2011 at 1:10 p.m., revealed a Catering Consultant obtaining food trays from the food cart located in the hallway and delivering the trays to patient rooms. Continued observation revealed the door remained open to the food cart containing ready to serve food trays with uncovered rolls and pie. Continued observation revealed staff and visitors passing the open food cart containing the uncovered food items.

Review of the facility policy Tray Identification/Delivery/Pick-up, policy #C032, revised December 2009, revealed " ...Trays are delivered in closed food carts, or all food and utensil are covered or wrapped ..."

Interview on the 4700 hall with the Clinical Integration Leader on April 13, 2011 at 1:10 p.m., confirmed the unattended food cart was to be closed when not obtaining individual patient food trays and/or the food items were to be covered.

C/O # 27813