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LINDSAY MUNICIPAL HOSPITAL
PATIENT CARE ASSIGNMENTS
Tag No.: A0397
Based on record review and staff interview, it was determined the hospital failed to ensure a registered nurse (RN) assessed or supervised the assessment of all patients in the post-anesthesia care unit (PACU).
Findings:
On 03/13/14, four clinical records were reviewed for patients who had surgical procedures. Three of the four records documented an LPN performed the patient assessment at the time of admission to PACU and at the time of discharge from PACU.
The surgery manager verified an RN was not always present in the PACU when an LPN was assigned to that area. In addition, she verified when an RN was present, she/he was not required to review and sign off on LPN patient assessments.
32725
PHARMACIST RESPONSIBILITIES
Tag No.: A0492
28713
Based on document review and staff interview, it was determined the hospital failed to ensure the pharmacist adequately responded to reports of medication errors.
Findings:
On 03/13/14, the Pharmacy and Therapeutics committee meeting minutes were reviewed. The minutes documented a reporting of the numbers of medication errors. There was no documentation the pharmacist investigated the medication errors, performed a root cause analysis and collaborated with nursing and medical staff (and others) to implement corrective measures.
The pharmacist was not available at the time of the survey. The CEO was made aware of the findings. No comment was made.
FACILITIES, SUPPLIES, EQUIPMENT MAINTENANCE
Tag No.: A0724
28713
At the time of the survey, remodeling/construction projects had not been started. Therefore, compliance with this requirement could not be evaluated.
INFECTION PREVENTION CONTROL ABX STEWARDSHIP
Tag No.: A0747
28713
At the time of the survey, remodeling/construction projects had not been started. Therefore, compliance with this requirement could not be evaluated.
INFECTION CONTROL PROGRAM
Tag No.: A0749
28713
At the time of the survey, remodeling/construction projects had not been started. Therefore, compliance with this requirement could not be evaluated.
SURGICAL SERVICES
Tag No.: A0940
28713
At the time of the survey, remodeling/construction projects had not been started. Therefore, compliance with this requirement could not be evaluated.