HospitalInspections.org

Based on record review, policy review and staff interview, it was determined the facility failed to ensure medications were administered as ordered by the physician and according to facility policy for 6 (#1,#2,#3,#4,#5, and #10) of 10 sampled patients.



Findings include:

1. Review of the medical record for patient #1 revealed the patient was admitted with the diagnoses of myocardial infarction, type I diabetes and renal insufficiency. Review of the physician orders for the patient revealed the patient was to have bedside glucose monitoring before meals and at night. Review of the nursing documentation of the blood glucose results and the administration of insulin revealed that on 6/30/11 at 6:00 a.m. the blood glucose was 381. The sliding scale calls for 20 units of regular insulin to be administered. The nurse had administered only 16 units. On 7/4/11 at 11:30 a.m. the blood glucose was 420. Again the insulin dose was to be 20. The nurse administered only 16 units. There was no explanation regarding the lower dose.


2. Review of the medical record revealed patient # 2 was admitted on 6/28/11 with the diagnosis of syncope following a motor vehicle accident. Review of the physician orders revealed the physician wrote admission orders on 6/28/11 at 7:15 p.m., which included an order for Seroquel 50 milligrams (mg) twice daily. Review of the Medication Administration (MAR) revealed the pharmacist had profiled the medication to be started on 6/28/11 at 9:00 p.m. There was no documentation that the medication had been administered. Interview with the Director of Quality and CNO on 11/3/11 at approximately 3:00 p.m. confirmed the medication was not administered and should have been.

3. Review of the medical record of patient #3 revealed the patient was admitted to the facility on 11/1/11 with the diagnosis of substernal chest pain and unstable angina. Review of the physician orders revealed an order was written for Trandate 20 mg intravenously now and Vasotec 2.5 mg. now on 11/2/11 at 8:00 a.m. Review of the MAR revealed that the Vasotec was administered at 9:35 a.m. and the Trandate was administered at 10:12 a.m. Interview with the CNO on 11/4/11 at 10:15 a.m. confirmed that the facility ' s policy " Medication Administration Standard Times " " MM1439, last reviewed 5/10, required that the medication be administered 30 minutes and that the medications were not administered timely.


4. Review of the medical record of patient #4 was admitted to the facility on 10/30/11 with the diagnosis of coronary heart artery disease and unstable angina. Review of the physician orders revealed a physician order for " Nitroglycerine drip per protocol." Review of the MAR revealed that the drip was initiated at 9:08 a.m. on 10/30/11. The CNO who was present at the time of the record review on 11/4/11 at approximately 9:15 a.m. was asked for the protocol for the nitroglycerine drip. She indicated that the physician is to write the parameters as part of the order and confirmed the order should have been clarified.

5. Review of the medical record of patient #5 revealed the patient was admitted to the facility on 11/3/11 with the diagnosis of lower extremity edema and blurred vision. The physician wrote an order for bedside glucose monitoring before meals and at night with regular insulin per a sliding scale. On 11/3/11 at 8:58 a.m., the blood glucose was documented as being 202. The sliding scale called for 8 units of regular insulin to be administered. Review of the MAR revealed the only 5 units were administered. There was no explanation for the lower dosage. The staff nurse who was present during the record review on 11/4/11 at 1:50 a.m. confirmed the dosage administered was inaccurate.

6. Review of the medical record of patient #10 revealed the patient was admitted to the facility on 11/1/11 with the chief complaint of generalized weakness. Review of the physician orders revealed an order for potassium 40 milliequivalents by mouth now and 1 amp of calcium gluconate intravenously over 30 minutes now on 11/2/11 at 12:40 a.m. Review of the MAR revealed the medications were not given until 2:21 a.m. The CNO, who was present during record review on 11/4/11 at approximately 12:30 p.m., confirmed the nursing staff did not comply with the facility policy.