HospitalInspections.org

Based on medical record review and interview, the facility failed to ensure medications were administered in accordance with phyisican orders for two of 11 sampled patients (Patient #7 and Patient #8). The census was 153.

Findings include:

1. The medical record review for Patient #8 was completed 10/22/2020. An emergency department physician note dated 06/10/2020 at 4:14 PM stated the patient presented to the emergency department with a chief complaint of chest pain and shortness of breath. The review revealed the patient's blood sugar was 571 and he/she had diagnoses of asthma, congestive heart failure, chronic obstructive pulmonary disease, diabetes, hypertension, neuropathy and sleep apnea.

A nursing note dated 06/10/2020 at 5:30 PM stated the patient was diaphoretic and having difficulty breathing. On 06/10/2020 at 7:36 PM the patient had a heart rate of 132 beats per minute and respirations of 32 breaths per minute. At 8:23 PM the patient was intubated and placed on a ventilator.

A diprivan intravenous drip (used to sedate a patient who is under critical care and needs a mechanical ventilator) was started on the patient at 8:26 PM on 06/10/2020 at a drip rate of 20 mcg/kg/minute. The medical record review revealed the diprivan was then titrated down by 20 mcg/kg/minute from 50 mcg/kg/minute at 8:50 PM to 30 mcg/kg/minute at 9:05 PM.

The medical record review revealed on 06/10/2020 at 8:32 PM the diprivan was ordered to begin at 10 micrograms/kilogram/minute (mcg/kg/minute) and then be titrated by 10 mcg/kg/minute to a maximum dose of 50 mcg/kg/minute.

On 10/21/2020 at 4:33 PM in an interview, Staff N confirmed the finding.

2. The medical record review for Patient #7 was completed on 10/22/2020. An emergency room physician progress note dated 10/19/2020 at 5:01 PM stated the patient presented for trauma to the left lower extremity after a fall. The note stated the fall occurred while transferring from his/her motorized wheelchair into the car. The note stated the patient had an open compound fracture of the left distal tibia-fibula and ankle region. The note stated the patient had a comminuted distal fibular metaphyseal fracture and medial malleolar fracture.

A post operative note dated 10/19/2020 at 8:02 PM stated that due to blood pressure issues the patient was transferred directly to the surgical intensive care unit.

The medical record review revealed an order dated 10/19/20 at 8:39 PM for diprivan intravenous drip to begin at 10 mcg/kg/minute, to then be titrated by 10 mcg/kg/minute, to a maximum dose of 50 mcg/kg/minute.

On 10/19/2020 at 9:49 PM the drip was decreased by 5 mcg/kg/minute from 15 mcg/kg/minute to 10 mcg/kg/minute, on 10/20/2020 at 2:00 AM the drip was increased by 5 mcg/kg/minute from 10 mcg/kg/minute to 15 mcg/kg/minute, at 2:34 PM it was decreased by 5 mcg/kg/minute from 15 mcg/kg/minute to 10 mcg/kg/minute, and at 3:12 PM it was increased by 2.5 mcg/kg/minute from 10 mcg/kg/minute to 12.5 mcg/kg/minute.

On 10/19/2020 at 8:39 PM fentanyl (used for sedation and pain control) was ordered to begin at 75 mcg/hr and to be titrated by 25 mcg/hr every 15 minutes to a maximum dose of 300 mcg/hr.

The medical record review revealed on 10/20/2020 from 6:19 AM to 1:00 PM the drip had been turned off entirely.

Further review of the record revealed a physician order dated 10/19/2020 at 7:34 PM for a levophed drip (used for low blood pressure) to begin at 5 mcg/minute and then titrated by 5 mcg/minute every 5 minutes to a maximum dose of 100 mcg/minute.

On 10/20/2020 at 6:12 AM the drip was infusing at 5 mcg/minute, it was increased to 7.5 mcg/minute at 7:43 AM, increased again to 10 mcg/minute at 8:37 AM, decreased to 9 mcg/minute at 9:22 AM, decreased to 8 mcg/minute at 10:09 AM, decreased to 6 mcg/minute at 11:20 AM, increased to 8 mcg/minute at 11:51 AM and then increased to 10 mcg/minute at 11:53 AM.

On 10/20/2020 at 3:50 PM in an interview, Staff O confirmed the findings.