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Based on interviews with staff, medical record review, and review of policies/procedures, it was determined the hospital failed to ensure that a dilitiazem (Cardizem) drip was administered according to a written protocol, with hemodynamic parameters ordered for titration, by the physician, for 1 of 1 patient (Pt) on a Cardizem drip in the intensive care unit (ICU). This failure has the potential for patient harm if the drug was administered incorrectly.

Findings include:

The facility policy titled Administration of Medications: General, effective 05/17/07, required: "...Requirement for a valid order. Individuals who prepare, dispense, and administer medications shall do so only upon the order of a practitioner who has been granted clinical privileges and is legally authorized to prescribe/order medications...."

The facility policy titled High-Risk Medications, revised 09/11/15, included the following: "...High-risk (High-alert) medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error. Although mistakes may or may not be more common with these drugs, the consequences of an error with these medications are clearly more devastating to patients...LA PAZ REGIONAL HOSPITAL HIGH-RICK MEDICATIONS...Diltiazem...."

Patient # 5 was admitted to the hospital from the emergency department on 12/12/16, at 1440 hours, with shortness of breath, tachycardia with a rapid ventricular response. According to documentation in the medical record by RN#1, the patient had a Diltiazem drip,an intravenous (IV) medication running at a rate of 15 milliliters (ml) per hour (hr). The 125 ml IV bag had 125 mg of Diltiazem added and was infusing at 15 ml/hr.

The following entries were in Pt #5's medical record while in the ICU:

12/12/16, at 16:20 hours: ICU registered nurse (RN), documented: "...Intravenous {IV} Fluids Infusing: cardizem at 15 mg tolerating well...."

12/13/16, at 0300 hours: ICU RN documented: "...Heart rate climbed in past two hours and is sustaining in low 100's. Titrated Cardizem up to 17.5 ml/hr...."

12/13/16, at 0700 hours: ICU RN documented: "...Cardizem drip decreased to 15mg/hr...."

12/13/16, 0800 hours: ICU RN documented: "...Cardizem decreased to 12.5 mg/hr...."

12/13/16, 1230 hours: ICU RN documented: "...Cardizem drip discontinued...."

An interview with RN #15 was conducted on 12/14/16 at 1130 hours, during the medical record review of Pt. #5. She confirmed the hospital did not have an order for the Cardizem drip. She called the Pharmacist to confirm there was not an order in the medical record. The Pharmacist explained on 12/14/16, at 1145 hours, that he could see that the physician ordered "Cardizem drip titrate." When asked what the parameters were for the titration order he explained that there is a "protocol" for Cardizem that would be in the medical record by the ordering physician. The surveyor requested the protocol. The chief nursing officer (CNO) and RN # 15, confirmed that Pt #5's medical record did not have the "Cardizem Administration Protocol" for the Cardizem drip.

The protocol requires that a physician document hemodynamic parameters for titration.

The CNO and RN #15 both confirmed on 12/14/16 at 1200 hours, the medical record did not contain the protocol.

Patient #5 was in the ICU receiving a Cardizem drip that was titrated by RN's without hemodynamic parameters documented by a physician on the Cardizem Administration Protocol. The patient received a Cardizem drip for approximately 22 hours without a complete order for titration.