HospitalInspections.org

Based on medical record reviews, staff interviews, and facility policy review, the facility failed to ensure medications were given timely as ordered. This effected ten of ten medical records reviewed (#1, #2, #3, #4, #5, #6, #7, #8, #9 and #10).

Findings include:

The medical record review of patient #5 on 12/19/12 revealed documentation on the electronic medication administration report (eMAR) dated 12/10/12 the medication Norco 10/325 milligrams (a medication used to control moderate to severe pain) was scheduled to be given at 1200 hours, however, it was documented as given at 1308 hours. On 12/11/12 the medication Celebrex 200 milligrams (mg) (an anti inflammatory medication), was scheduled to be administrated at 0900 hours, however it was documented that the medication was given at 1002. The medication Tylenol 650 mg (medication used for pain control) was scheduled to be given at 2200 hours; documentation revealed the medication was given at 2005 hours. Review of the eMAR dated 12/13/12 revealed the medication Colace 100 mg (a medication used to promote bowel movement) was scheduled to be administered at 2100 hours, the documentation revealed it was given at 2323 hours.

The medical record review of patient #6 was on 12/19/12. The eMAR dated 12/08/12 revealed Tylenol 650 mg (a medication used to control pain) was scheduled to be given at 1400 hours, the documentation revealed the medication was administered at 1621 hours. On the same day Lamictal 150 mg (an anti-epileptic) was scheduled to be given at 0900 hours, documentation revealed it was given at 0822 hours, Coumadin 2.5 mg (a medication used to prevent blood clots) was scheduled to be given at 1800 hours, however, the documentation revealed the medication was given at 1620 hours. On 12/09/12 the medication Tylenol 650 mg was scheduled to be given at 1400 hours, documentation revealed the medication was administered at 1522 hours. The eMar dated 12/09/12 revealed the medication Protonix 40 mg (used to decrease the amount of acid produced in the stomach), was scheduled to be administered at 0700 hours however, the documentation revealed the medication was given at 0546 hours. On 12/13/12 the eMar revealed Protonix 40 mg was scheduled to be given at 0700 hours, documentation revealed the medication was given at 0600 hours. Flexeril 10 mg (an anti-inflammatory medication) was scheduled to be given at 2100 hours, documentation revealed the medication was given at 2236 hours. Toprol XL 100 mg (a medication used to control high blood pressure) was scheduled to be given at 2100 hours; however, documentation revealed the medication was administered at 2236 hours. MS Contin 15mg (a medication used to control severe pain) was scheduled to be given at 2100 hours; documentation revealed the medication was administered at 2235 hours.

During medical record review of patient #7 on 12/19/12 it was noted on eMAR dated 11/16/12 the medication Celebrex 200 milligrams (mg) was scheduled to be administered at 2100 hours, however it was documented the medication was given at 2000 hours, one hour before the scheduled time. Other medications for the same day included Lovenox 30 mg (medication to prevent blood clots), time scheduled 2100, time given 2000. Tylenol 650 mg was scheduled to be given at 2200, documented as given at 2000. Review of the eMAR for the date of 11/17/12 revealed the medication Januvia 50 mg (a medication used to control blood glucose) was scheduled to be administered at 0800 hours and was documented as given at 1004. Other medications for the same day included Glucophage 1000 mg (a medication used to control blood glucose) was scheduled to be given at 0800 and was documented as administrated at 1003 hours. Lopressor 25 mg (a medication used to control blood pressure) scheduled to be administrated at 0900 and was given at 1004. Review of the eMAR for the date 11/18/12 revealed Lopressor 25 mg was scheduled to be given at 0900 and was documented administered at 0758.

Interview with Staff D on 12/18/12 at 2:30 PM revealed medications can be administrated one hour before or one hour after the scheduled time listed on the eMAR. This was also verified by Staff C.

Review of facility policy M-04 titled Medication Administration Guidelines; " The acceptable range for administration is thirty (30) minutes before or after the scheduled time. This was confirmed with Staff A on 12/19/12 at approximately 11:30 AM.





31007

During the medical record review of patient #1 on 12/19/12 it was noted on the eMAR dated 12/12/12 the medication Protonix 40 milligrams (mg) was scheduled to be administered at 0700 and was documented as given at 0434, two hours, twenty five minutes before the schedule time. Other medications for the same day included Novolog Flexpen 300 units/3 milliliters (ml) a medication used to control blood sugar, was scheduled to be administered at 2100, it was administered at 2209 over one hour after scheduled administration time. Inderal 10 mg two times daily used to treat high blood pressure, was scheduled for 2100, it was administered at 2210. Ativan 1 mg this medication is used for anxiety, was scheduled for 2100, it was administered at 2207. Also Synthroid 200 micrograms (mcg) used to treat hypothyroid issues was scheduled at 0700, it was given at 0434. Review of the eMAR for the date of 12/16/12 revealed the medication Apresoline 25 mg a medication used to treat hypertension, was scheduled to be administered at 2200, however it was documented given at 2038. Another medication for the same day was Lasix 40 mg a diuretic used to remove excess water from the body, was scheduled for 1800, it was given at 1656. Further review of the eMAR revealed on 12/18/12 the medication Protonix 40 mg was scheduled to be given at 0700, but it was documented to have been given at 0553. Other medications given the same day included Inderal 10 mg a medication used to treat high blood pressure, was scheduled to be given at 2100, it was given at 1958. Synthroid 200 mcg used to treat an under active thyroid, was scheduled for 0700, it was given at 0553.

During medical record review of patient #2 on 12/19/12 it was noted on eMAR Administration Report dated 12/14/12 the medication Klonopin 0.5 mg a medication used for the treatment of anxiety, it was scheduled to be administered at 1200 and was documented as given at 1308 over an hour after the scheduled time. Other medications for the same day included Colace 100 mg a medication used to promote bowel movements, was scheduled to be administered at 0900, it was administered at 0947. Heparin Sodium 7500 units a medication used to decrease blood clotting, was scheduled for 1400, it was administered at 1309. Review of the eMAR for the date of 12/16/12 revealed the medication Klonopin 0.5 mg, a medication used for the treatment of anxiety, was scheduled to be administered at 0000, however it was documented given at 0059. Another dose of Klonopin 0.5 mg was scheduled to be given at 1800, the medication was administered at 1700. Other medications for the same day were Heparin Sodium 7500 units, was scheduled for 2200, it was given at 2053. Provigil 100 mg used for sleeping disorders, was scheduled for 1300, it was given at 1145. Protonix 40 mg a medication used to decrease the amount of acid produced in the stomach, was scheduled to be administered at 0700, it was administered at 0601. Further review of the eMAR revealed on 12/17/12 the medication Protonix 40 mg was scheduled to be given at 0700, but it was documented given at 0602. Other medications given the same day include Heparin Sodium 7500 units, was scheduled to be given at 2200, administered at 1946. Lopressor 25 mg used to treat high blood pressure, was scheduled for 2100, was administered at 1946.

During medical record review of patient #3 on 12/19/12 it was noted on eMAR Administration Report dated 09/25/12 the medication Norvasc 10 mg a medication used for the treatment of high blood pressure, was scheduled to be administered at 1016 and was documented as given at 1118 over an hour after the scheduled time. Other medications for the same day included Apresoline 50 mg a medication used to treat high blood pressure, was scheduled to be administered at 1400, was administered at 1534. Aspirin 81 mg a medication used to decrease blood clotting, was scheduled for 1300, it was administered at 1534. Review of the eMAR for the date of 09/27/12 revealed the medication Apresoline 50 mg, was scheduled to be administered at 0600, however it was documented given at 0725. Further review of the eMAR revealed on 09/29/12 the medication Coreg 25 mg used to treat high blood pressure, was scheduled to be given at 0800, but was documented to have been given at 0906. Another medication given the same day was Tegretol 200 mg used to treat several psychiatric and seizure disorders, was scheduled to be given at 2100, was documented as administered at 2202.

During medical record review of patient #4 on 12/19/12 it was noted on eMAR Administration Report dated 08/07/12 the medication Lovenox 70 mg a medication used for the treatment of clotting disorders, it was scheduled to be administered at 2100 and was documented as given at 2258. Other medications for the same day included Senokot 2 tablets a stimulant laxative for relieving constipation, was scheduled to be administered at 2100, it was administered at 2314. Colace 100 mg a medication used to promote bowel movements, was scheduled for 2100, it was administered at 2314. Review of the eMAR for the date of 08/23/12 revealed the medication Plavix 75 mg a medication used to decrease blood clotting, was scheduled to be administered at 1300, however it was documented to be given at 1429. Further review of the eMAR revealed on 09/29/12 the medication Lovenox 40 mg, was scheduled to be given at 1300, but it was documented to have been given at 1428.








31597

During medical record review of Patient #8 on 12/18/12 it was noted on eMAR Administration Report dated 12/14/12 the medication Heparin Sodium (an anticoagulant) 5000 units was scheduled to be administered at 2100 and was documented as given at 2333. Aggrenox (inhibits thrombus formation) one tablet was scheduled to be administered at 2100, it was administered at 2331. Colace 100 mg a medication used to promote bowel movements, was scheduled for 2100, it was administered at 2331.
Voltaren 75 mg (anti-inflammatory drug) was scheduled to be administered at 2100, it was administered at 2339. Normodyne/Trandate (treats high blood pressure) 300 mg was scheduled to be administered at 2100, it was administered at 2337. Lopressor (treats high blood pressure) 37.5 mg was scheduled to be administered at 2100, it was administered at 2335. Desenex (a topical antifungal agent) was scheduled to be administered at 2100, it was administered at 2332. K-Lor (a potassium replacement medication) 20 MEQ was scheduled to be administered at 2100, it was administered at 2334. Senokot (a laxative) two tablets were scheduled to be administered at 2100, they were administered at 2338.

During the medical record review of Patient # 9 on 12/18/12, it was noted on the eMAR Administration Report dated 12/17/12, the medication Heparin Sodium (an anticoagulant) 5000 units was scheduled to be administered at 2100, it was administered at 2044.

During medical record review of Patient #10 on 12/19/20, it was noted on the eMAR Administration Report dated 10/30/12, the medication Protonix ( a medication to inhibit gastric secretion) 40 mg was scheduled to be administered at 0700, it was administered at 0837. Synthroid (a thyroid hormone replacement medication) 50 mcg was scheduled to be administered at 0700, it was administered at 0837. Colace 100mg, a medication used to promote bowel movements, was scheduled to be administered at 2100, it was administered at 1950. Omega-3 Fish Oil (dietary supplement) 1000 mg was scheduled to be administered at 2100, it was administered at 1950.

Based on medical record reviews, staff interviews, and facility policy review, the facility failed to ensure medications were given timely as ordered. This effected ten of ten medical records reviewed (#1, #2, #3, #4, #5, #6, #7, #8, #9 and #10).

Findings include:

The medical record review of patient #5 on 12/19/12 revealed documentation on the electronic medication administration report (eMAR) dated 12/10/12 the medication Norco 10/325 milligrams (a medication used to control moderate to severe pain) was scheduled to be given at 1200 hours, however, it was documented as given at 1308 hours. On 12/11/12 the medication Celebrex 200 milligrams (mg) (an anti inflammatory medication), was scheduled to be administrated at 0900 hours, however it was documented that the medication was given at 1002. The medication Tylenol 650 mg (medication used for pain control) was scheduled to be given at 2200 hours; documentation revealed the medication was given at 2005 hours. Review of the eMAR dated 12/13/12 revealed the medication Colace 100 mg (a medication used to promote bowel movement) was scheduled to be administered at 2100 hours, the documentation revealed it was given at 2323 hours.

The medical record review of patient #6 was on 12/19/12. The eMAR dated 12/08/12 revealed Tylenol 650 mg (a medication used to control pain) was scheduled to be given at 1400 hours, the documentation revealed the medication was administered at 1621 hours. On the same day Lamictal 150 mg (an anti-epileptic) was scheduled to be given at 0900 hours, documentation revealed it was given at 0822 hours, Coumadin 2.5 mg (a medication used to prevent blood clots) was scheduled to be given at 1800 hours, however, the documentation revealed the medication was given at 1620 hours. On 12/09/12 the medication Tylenol 650 mg was scheduled to be given at 1400 hours, documentation revealed the medication was administered at 1522 hours. The eMar dated 12/09/12 revealed the medication Protonix 40 mg (used to decrease the amount of acid produced in the stomach), was scheduled to be administered at 0700 hours however, the documentation revealed the medication was given at 0546 hours. On 12/13/12 the eMar revealed Protonix 40 mg was scheduled to be given at 0700 hours, documentation revealed the medication was given at 0600 hours. Flexeril 10 mg (an anti-inflammatory medication) was scheduled to be given at 2100 hours, documentation revealed the medication was given at 2236 hours. Toprol XL 100 mg (a medication used to control high blood pressure) was scheduled to be given at 2100 hours; however, documentation revealed the medication was administered at 2236 hours. MS Contin 15mg (a medication used to control severe pain) was scheduled to be given at 2100 hours; documentation revealed the medication was administered at 2235 hours.

During medical record review of patient #7 on 12/19/12 it was noted on eMAR dated 11/16/12 the medication Celebrex 200 milligrams (mg) was scheduled to be administered at 2100 hours, however it was documented the medication was given at 2000 hours, one hour before the scheduled time. Other medications for the same day included Lovenox 30 mg (medication to prevent blood clots), time scheduled 2100, time given 2000. Tylenol 650 mg was scheduled to be given at 2200, documented as given at 2000. Review of the eMAR for the date of 11/17/12 revealed the medication Januvia 50 mg (a medication used to control blood glucose) was scheduled to be administered at 0800 hours and was documented as given at 1004. Other medications for the same day included Glucophage 1000 mg (a medication used to control blood glucose) was scheduled to be given at 0800 and was documented as administrated at 1003 hours. Lopressor 25 mg (a medication used to control blood pressure) scheduled to be administrated at 0900 and was given at 1004. Review of the eMAR for the date 11/18/12 revealed Lopressor 25 mg was scheduled to be given at 0900 and was documented administered at 0758.

Interview with Staff D on 12/18/12 at 2:30 PM revealed medications can be administrated one hour before or one hour after the scheduled time listed on the eMAR. This was also verified by Staff C.

Review of facility policy M-04 titled Medication Administration Guidelines; " The acceptable range for administration is thirty (30) minutes before or after the scheduled time. This was confirmed with Staff A on 12/19/12 at approximately 11:30 AM.





31007

During the medical record review of patient #1 on 12/19/12 it was noted on the eMAR dated 12/12/12 the medication Protonix 40 milligrams (mg) was scheduled to be administered at 0700 and was documented as given at 0434, two hours, twenty five minutes before the schedule time. Other medications for the same day included Novolog Flexpen 300 units/3 milliliters (ml) a medication used to control blood sugar, was scheduled to be administered at 2100, it was administered at 2209 over one hour after scheduled administration time. Inderal 10 mg two times daily used to treat high blood pressure, was scheduled for 2100, it was administered at 2210. Ativan 1 mg this medication is used for anxiety, was scheduled for 2100, it was administered at 2207. Also Synthroid 200 micrograms (mcg) used to treat hypothyroid issues was scheduled at 0700, it was given at 0434. Review of the eMAR for the date of 12/16/12 revealed the medication Apresoline 25 mg a medication used to treat hypertension, was scheduled to be administered at 2200, however it was documented given at 2038. Another medication for the same day was Lasix 40 mg a diuretic used to remove excess water from the body, was scheduled for 1800, it was given at 1656. Further review of the eMAR revealed on 12/18/12 the medication Protonix 40 mg was scheduled to be given at 0700, but it was documented to have been given at 0553. Other medications given the same day included Inderal 10 mg a medication used to treat high blood pressure, was scheduled to be given at 2100, it was given at 1958. Synthroid 200 mcg used to treat an under active thyroid, was scheduled for 0700, it was given at 0553.

During medical record review of patient #2 on 12/19/12 it was noted on eMAR Administration Report dated 12/14/12 the medication Klonopin 0.5 mg a medication used for the treatment of anxiety, it was scheduled to be administered at 1200 and was documented as given at 1308 over an hour after the scheduled time. Other medications for the same day included Colace 100 mg a medication used to promote bowel movements, was scheduled to be administered at 0900, it was administered at 0947. Heparin Sodium 7500 units a medication used to decrease blood clotting, was scheduled for 1400, it was administered at 1309. Review of the eMAR for the date of 12/16/12 revealed the medication Klonopin 0.5 mg, a medication used for the treatment of anxiety, was scheduled to be administered at 0000, however it was documented given at 0059. Another dose of Klonopin 0.5 mg was scheduled to be given at 1800, the medication was administered at 1700. Other medications for the same day were Heparin Sodium 7500 units, was scheduled for 2200, it was given at 2053. Provigil 100 mg used for sleeping disorders, was scheduled for 1300, it was given at 1145. Protonix 40 mg a medication used to decrease the amount of acid produced in the stomach, was scheduled to be administered at 0700, it was administered at 0601. Further review of the eMAR revealed on 12/17/12 the medication Protonix 40 mg was scheduled to be given at 0700, but it was documented given at 0602. Other medications given the same day include Heparin Sodium 7500 units, was scheduled to be given at 2200, administered at 1946. Lopressor 25 mg used to treat high blood pressure, was scheduled for 2100, was administered at 1946.

During medical record review of patient #3 on 12/19/12 it was noted on eMAR Administration Report dated 09/25/12 the medication Norvasc 10 mg a medication used for the treatment of high blood pressure, was scheduled to be administered at 1016 and was documented as given at 1118 over an hour after the scheduled time. Other medications for the same day included Apresoline 50 mg a medicat