HospitalInspections.org

Based on interview and record review nursing staff failed to assess patient allergy status and administered morphine although the patient had been identified as having allergy to the drug. (Patient #1) Findings include:

1. Per review on 1/19/10 a staff nurse on 10/21/09 at 16:45 administered Morphine 1 mg IV (intravenously) although the patient was identified to have an allergy to the medication. Per review of Emergency Department documentation, the nursing note dated 10/19/09 states "Allergy/Adverse Reaction" included the drug Morphine. The medication allergy was also recorded by the Paramedic on the Patient Information EMS (Emergency Medical System) form completed during transport of Patient #1 to the hospital. In addition, the "Patient Card - X Part A" dated 10/19/09 and completed by nursing also identified Patient #1 to have an allergy to Morphine. Per interview on 1/19/10 at 4:20 PM the nurse who administered the medication confirmed he/she was not aware the patient had an allergy to Morphine.

Based on interview and record review, the nursing care plan failed to address a patient's agitated state along with non-pharmacological interventions to reduce the agitation and anxiety for 1 of 11 patients in the total sample. (Patient #1) Findings include:

1. Per review on 1/19/10, Patient #1 experienced periods of agitation and anxiety requiring the use of an anti-anxiolytic medication on 6 separate occasions during hospitalization from 10/19/09 through 10/27/09 . Nursing notes describe Patient #1 attempting to climb out of bed, removing oxygen nasal cannula tubing, complaints of pain, experiencing periods of confusion with restlessness. The care plan did not address the problem of agitation nor interventions developed to assist the patient in reducing agitation and anxiety prior to the administration of anxiolytic medication. The Director of the 5 th Floor Patient Unit confirmed on the afternoon of 1/19/10 the nursing care plan for Patient #1 did not remain current to reflect additional patient needs and interventions.

Based on interview and record review the hospital failed to assure medications were administered in accordance with physician orders and in accordance with accepted standards of practice for 1 of 11 patients in the total sample. (Patient #1) Findings include:

1. Per review on 1/20/10 nursing staff withheld the daily administration of a cardiac medication (Cardizem CD 240 mg orally) and an antihypertensive medication (Atenolol 50 mg. orally) over a 3 day period (10/21/09 through 10/23/09) without notification to the prescribing physician until 2:30 PM on 10/23/09. This was verified by the Chief Nursing Officer on the afternoon of 1/20/10.

2.. Per review on 1/19/10, a staff nurse failed to maintain accepted standards of practice on 10/21/09 at 4:45 PM when he/she administered Morphine 1 mg IV (intravenously) although the patient was identified to have an allergy to the medication. Per review of Emergency Department documentation, the nursing note dated 10/19/09 states "Allergy/Adverse Reaction" included the drug Morphine. The medication allergy was also recorded by the Paramedic on the Patient Information EMS (Emergency Medical System) form completed during transport of Patient #1 to the hospital. In addition, the "Patient Card - X Part A" dated 10/19/09 and completed by nursing also identified Patient #1 to have an allergy to Morphine. Per interview on 1/19/10 at 4:20 PM the nurse who administered the medication confirmed he/she was not aware the patient had an allergy to Morphine.