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Based on interview and document review the hospital failed to ensure all telephone orders were dated, timed and authenticated within twenty-four hours for 6 of 32 patients (P32, P21, P22, P20, P23 and P31) reviewed for nursing services.
Findings include:
P32 had a telephone order dated 8/30/13 at 2150 that read, "Ceftriaxone GM [gram] IV [intravenous therapy] Q [every] 24H [hours]." T.O. [telephone order]" Physician- A. The order was signed, dated and authenticated by physician-A on 9/4/13.
P21 had a telephone order dated 9/2/13 at 0525 that read, "Duoneb Q [every] 6H [hours]. "T.O. [telephone order]" Physician-A. The order was signed, dated and authenticated by physician-A on 9/4/13.
P21 had a telephone order dated 9/2/13 at 0610 that read, "D/C [discontinue] 40 meq [millequivalent] potassium now as patient had in the ED [emergency department] start the 20 meq [millequivalent] potassium BID [twice a day] this AM [morning]." "T.O. [telephone order]" Physician- A. The order was signed, dated and authenticated by physician-A on 9/4/13.
P22 had a telephone order dated 8/31/13 at 2330 that read, "Refresh tears, both eyes PRN [as needed] for dryness. T.O. [telephone order]" Physician- A. The order was signed, dated and authenticated by physician-A on 9/4/13.
P22 had a telephone order dated 8/31/13 at 2100 that read, "Discontinue cozar, hold hydralazine tonight, hold catapress tonight." "T.O. [telephone order]" Physician- A. The order was signed, dated and authenticated by physician-A on 9/4/13.
P22 had a telephone order dated 8/31/13 at 2110 that read, "at 2300 tonight, if BP [blood pressure] is > [greater than] 150 systolic give hydralazine 50mg [milligrams] PO [by mouth]." T.O. [telephone order] Physician- A. The order was signed, dated and authenticated by Physician-A on 9/4/13.
P20 had a telephone order dated 8/29/13 at 2220 that read, "Hold evening dose of Metoprolol." T.O. [telephone order] Physician- A. The order was signed, dated and authenticated by Physician-A on 9/3/13.
P23 had a telephone order dated 9/2/13 at 0404 that read, "NS [normal saline] 250 ml [milliliters] bolus then NS [normal saline] @ [at] 100 ml/hr [milliliters per hour]." T.O. [telephone order] Physician- A. The order was signed, dated and authenticated by Physician-A on 9/4/13.
P23 had a telephone order dated 8/31/13 at 2110 that read, "[change] IV [intravenous therapy] fluids to NS [normal saline] [with] 20 KCL [potassium chloride] at 150 ml/hr [milliliters per hour]." T.O. [telephone order] Physician- A. The order was not signed, dated or authenticated by Physician-A.
P23 had a telephone order dated 8/31/13 at 2205 that read, "Maalox 30ml [milliliters] PO [by mouth] QID [four times a day] PRN [as needed] heartburn. Prilosec 40 mg [milligrams] PO [by mouth] daily." T.O. [telephone order] Physician- A. The order was not signed, dated or authenticated by Physician-A.
P23 had a telephone order dated 8/31/13 at 0125 that read, "Hold lisinopril until further notice." T.O. [telephone order] Physician- A. The order was signed, dated and authenticated by Physician-A on 9/4/13.
P23 had a telephone order dated 8/31/13 at 0246 that read, "Give 250 ml [milliliters] NaCl [sodium chloride] Bolus IV [intravenous therapy] x [times] 1 Now." T.O. [telephone order] Physician- A. The order was signed, dated and authenticated by Physician-A on 9/4/13.
P23 had a telephone order dated 8/29/13 at 1910 that read, "Ativan 0.5mg [milligrams] PO [by mouth]Now 1 x [time] dose." T.O. [telephone order] Physician- A. The order was not signed, dated or authenticated by Physician-A.
P23 had a telephone order dated 8/31/13 at 0029 that read, "500 ml [milliliters] NaCl [sodium chloride] Bolus IV [intravenous therapy] x [times] 1 Now." T.O. [telephone order] Physician- A. The order was not signed, dated or authenticated by Physician-A.
P23 had a telephone order dated 8/31/13 at 0040 that read, "[after] bolus is complete increase D5 [Dextrose 5] NaCl [sodium chloride] 20 KCl [potassium chloride] to 150 ml/hr [milliliters per hour]." T.O. [telephone order] Physician- A. The order was not signed, dated or authenticated by Physician-A.
P31 had a telephone order dated 7/27/13 at 1940 that read, "Per dietician recommendation: 150 source 1.5 cal [calorie] 3 cans over 24 [hours] @ [at] 30 ml/hr [milliliters per hour]. No free water @ [at] this time d/t [due to] IVF [intravenous fluids] infusing." T.O. [telephone order] Physician- B. The order was signed, dated and authenticated by Physician-B on 8/9/13.
P31 had a telephone order dated 7/27/13 at 1415 that read, " [change] morphine to q [every] 2 [hours] prn [as needed. " T.O. [telephone order] Physician- B. The order was signed, dated and authenticated by Nurse Practitioner-A on 8/7/13.
P31 had a verbal order dated 7/26/13 at 1500 that read, "DC [discontinue] Duoneb, Albutrol Q4 to Q2 [every 4 to every 2 hours] PRN [as needed] for SOB [shortness of breath] start now, 20% mucomyst 4 ml [milliliters] one time now." V.O. [verbal order] Nurse Practitioner-A. The order was signed, dated and authenticated by Nurse Practitioner-A on 8/7/13.
P31 had a verbal order dated 7/26/13 at 1552 that read, "CPT [chest physical therapy] QID [four times a day], 20% mucomyst 4 ml [milliliters] QID [four times a day] 12 doses start this evening 91900-2000 time)." V.O. [verbal order] Nurse Practitioner-A. The order was signed, dated and authenticated by Nurse Practitioner-A on 8/7/13.
P31 had a verbal order dated 7/26/13 at 1555 that read, "Metoprolol 5mg [milligrams] IV [intravenous therapy] now." V.O. [verbal order] Nurse Practitioner-A. The order was signed, dated and authenticated by Nurse Practitioner-A on 8/7/13.
P31 had a telephone order dated 7/26/13 at 2155 that read, "Metoprolol 5mg [milligrams] IV [intravenous therapy] now." T.O. [telephone order] Physician- B. The order was signed, dated and authenticated by Physician-A on 8/9/13.
P31 had a telephone order dated 7/25/13 at 1115 that read, "Change xray to portable 1 view." T.O. [telephone order] Nurse Practitioner-A. The order was signed, dated and authenticated by Nurse Practitioner-A on 8/7/13.
P31 had a telephone order dated 7/25/13, untimed that read, "Xanax PO[by mouth] 0.25 mg [milligrams] x [times] 1 now." T.O. [telephone order] Nurse Practitioner-A. The order was signed, dated and authenticated by Nurse Practitioner-A on 8/7/13.
P31 had a telephone order dated 7/25/13, 1320 that read, "fentanyl patch 25 mcg/hr [micrograms per hour] change every three days, vicodin 5/325 tab 1 PO x 1 dose now." T.O. [telephone order] Nurse Practitioner-A. The order was signed, dated and authenticated by Nurse Practitioner-A on 8/7/13.
P31 had a telephone order dated 7/25/13, 1335 that read, "Toradol IV [intravenous therapy] 15 mg [milligrams] x [times] 1 now." T.O. [telephone order] Nurse Practitioner-A. The order was signed, dated and authenticated by Nurse Practitioner-A on 8/7/13.
P31 had a telephone order dated 7/25/13, 1430 that read, "Ativan 0.5 mg [milligrams] IV [intravenous therapy] x [times] 1 now." T.O. [telephone order] Nurse Practitioner-A. The order was signed, dated and authenticated by Nurse Practitioner-A on 8/7/13.
P31 had a verbal order dated 7/23/13, 1100 that read, "Renally adjust zosyn to 3.375 g [grams] IV [intravenous therapy] Q [every] 6 [hours], do not start amiodarone today, leave intervention as pending- continue to monitor INR [ ] and heart rate." V.O. [verbal order] Nurse Practitioner-A. The order was signed, dated and authenticated by Nurse Practitioner-A on 8/7/13.
P31 had a telephone order dated 7/22/13, 1257 that read, "D/C [discontinue] rocephin, start levaquin 750 mg [milligrams] IV [intravenous therapy] Q [every] 48 [hours] per renal dosing." T.O. [telephone order] Nurse Practitioner-A. The order was signed, dated and authenticated by Nurse Practitioner-A on 8/7/13.
P31 had a telephone order dated 7/21/13, 0920 that read, "iron level and TIBC [total iron binding capacity], ferritin. Vitamin B12 level, folate level, reticulocyte count, hemocoult x [times] 3, add to am labs if able, otherwise do 7/22/13 am." T.O. [telephone order] Nurse Practitioner-A. The order was signed, dated and authenticated by Nurse Practitioner-A on 8/7/13.
During an interview on 9/4/13, at 9:30 a.m., the registered nurse manager (RNM) indicated verbal orders and telephone orders should not be done. RNM indicated there may be a situation for an example code status, otherwise there is a hospitalist available on the floor twenty-four hours a day.
During an interview on 9/4/13, at 4:02 P.M., the nurse administrator verified telephone orders were to be signed within twenty-four hours.
Review of the Fairmont Medical Center Hospital, Mayo Health System, Medical Staff, Rules and Regulations dated August 2009 read, "All verbal/telephone orders must be dated, timed and authenticated within twenty-four (24) hours."

Based on observation, interview, and record review, the hospital was found to be out of compliance with the Condition of Participation related to the Physical Environment (42 CFR 482.41) related to lack of compliance with Life Safety Code requirements. These findings have the potential to affect all patients in the hospital. Findings included:

The hospital was found out of compliance with the Condition of Participation related to the Physical Environment (42 CFR 482.41) as evidenced by deficiencies issued as a result of a Life Safety Code inspection. Findings include:

Please refer to Life Safety Code inspection tags: K-0011, K-0029; K-0050; K-0052; K-0076; K-0147 for additional information.

Based on interview and document review, the hospital did not have a detailed plan for emergency water supply if their city water supply is not available or contaminated. This practice could affect all patients, families, and staff in the hospital.

Findings include:

During an interview with the director of environmental services it was learned that the current Emergency Operations Plan Policy which addressed emergency water on 9/5/2013 at 9:00 a.m. had been revised and the information in regards to how much potable (water that is safe to drink and use in meal preparation) and non-potable water (water that is used for flushing toilets, etc.) is needed depending on the current or estimated census in the hospital and how much will be needed for dietary, nursing, normal plant operations.

Review of the policy provided by the facility for emergency water was read and included the agreement with whom they will receive potable and non-potable water was identified but there was no information in regards to the quantity of potable and non-potable would be needed according to the census.