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Based on clinical record review, review of Medical Staff Bylaws and interview, it was determined verbal or telephone orders were not authenticated by the prescribing practitioner within 48 hours of obtaining the orders for 11 (Patient #1, #2, #4-#9, #13, #28 and #29) of 30 (Patient #1-30) patients. The failed practice did not ensure early identification and correction of an error. The failed practice affected the 11 patients and potentially all patients in the facility. The findings follow:

A. Review of the Medical Staff Bylaws on 08/10/12 revealed, "The attending physician or his/her designee is responsible for reviewing the orders for correctness, signing, dating and timing forty-eight (48) hours post verbal order."
B. Review of the clinical records for Patient #1, #2, #4-#9, #13, #28 and #29 on 08/09/12 and 08/10/12 revealed the following:
1) Patient #1's physician's orders from 08/01/12 to 08/04/12 revealed six of nine verbal or telephone orders were not signed by the practitioner within 48 hours of obtaining the order. The findings were confirmed in an interview with the Regulatory Officer on 08/10/12 at 1140.
2) Patient #2's physician's orders from 08/05/12 to 08/10/12 revealed four of six verbal or telephone orders were not signed by the practitioner within 48 hours of obtaining the order. The findings were confirmed in an interview with Regulatory Officer on 08/10/12 at 1330.
3) Patient #4's physician's orders from 08/04/12 to 08/07/12 revealed seven of seven verbal or telephone orders were not signed by the practitioner within 48 hours of obtaining the order. The findings were confirmed in an interview with the Regulatory Officer on 08/10/12 at 1330.
4) Patient #5's physician's orders from 07/27/12 to 08/05/12 revealed 43 of 46 verbal or telephone orders were not signed by the practitioner within 48 hours of obtaining the order. The findings were confirmed in an interview with the Service Line Administrator for Cardiovascular on 08/10/12 at 1100.
5) Patient #6's physician's orders from 08/02/12 to 08/05/12 revealed four of eight verbal or telephone orders were not signed by the practitioner within 48 hours of obtaining the order. The findings were confirmed in an interview with the Regulatory Officer on 08/10/12 at 0830.
6) Patient #7's physician's orders from 08/02/12 to 08/04/12 revealed 13 of 15 verbal or telephone orders were not signed by the practitioner within 48 hours of obtaining the order. The findings were confirmed in an interview with the Regulatory Officer on 08/10/12 at 0830.
7) Patient #8's physician's orders from 07/17/12 to 08/05/12 revealed 43 of 95 verbal or telephone orders were not signed by the practitioner within 48 hours of obtaining the order. The findings were confirmed in an interview with the Interim Manager of the Critical Care Unit on 08/10/12 at 0945.
8) Patient #9's physician's orders from 08/02/12 to 08/03/12 revealed 11 of 14 verbal or telephone orders were not signed by the practitioner within 48 hours of obtaining the order. The findings were confirmed in an interview with the Regulatory Officer on 08/10/12 at 0835.
9) Patient #13's physician's orders from 07/31/12 to 08/06/12 revealed three of four verbal or telephone orders were not signed by the practitioner within 48 hours of obtaining the order. The findings were confirmed in an interview with the Regulatory Officer on 08/10/12 at 1330.
10) Patient #28's physician's orders from 08/01/12 to 08/05/12 revealed 10 of 12 verbal or telephone orders were not signed by the practitioner within 48 hours of obtaining the order. The findings were confirmed in an interview with the Regulatory Officer on 08/10/12 at 1330.
11) Patient #28's physician's orders from 07/31/12 to 08/06/12 revealed 23 of 28 verbal or telephone orders were not signed by the practitioner within 48 hours of obtaining the order. The findings were confirmed in an interview with the Regulatory Officer on 08/10/12 at 1330.

Based on clinical record review and interview, it was determined 14 of 14 (Patient #1-#6, #8, #9, #13, #25, #26 and #28-#30) operative reports did not contain the time and/or date of the surgery. Failure to record the date and time of surgery on the operative report did not allow the clinical record and the operative report to be complete. The failed practice affected 14 of 14 patients and had the potential to affect all patients receiving a surgical procedure at the facility. The findings follow:

A. Review of Patient #1's clinical record on 08/10/12 revealed the "Operative Report and Proc (Procedure) Record" dated 08/01/12 did not contain the time of the procedure. The findings were confirmed in an interview with Regulatory Officer on 08/12/12 at 1140.
B. Review of Patient #2's clinical record on 08/10/12 revealed the "Operative Report" dictated on 08/07/12 did not contain the date or time of the procedure. The findings were confirmed in an interview with the Regulatory Officer on 08/10/12 at 1330.
C. Review of Patient #3's clinical record on 08/10/12 revealed the "Operative Report" dictated on 07/30/12 did not contain the date or time of the procedure. The findings were confirmed in an interview with the Service Line Administrator for Women's and Children on 08/10/12 at 1330.
D. Review of Patient #4's clinical record on 08/10/12 revealed the "Operative Report" dated 08/04/12 did not contain the time of the procedure. The findings were confirmed in an interview with the Regulatory Officer on 08/10/12 at 1330.
E. Review of Patient #5's clinical record on 08/10/12 revealed the "Operative Report" dictated on 07/31/12 and an "Operative Report" dictated on 07/27/12 did not contain the date or time of the procedure. The findings were confirmed in an interview with the Service Line Administrator for Cardiovascular on 08/10/12 at 1100.
F. Review of Patient #6's clinical record on 08/09/12 revealed the "Operative Report and Proc Record" dated 08/03/12 did not contain the time of the procedure. The findings were confirmed in an interview with the Regulatory Officer on 08/10/12 at 0830.
G. Review of Patient #8's clinical record on 08/10/12 revealed the "Operative Reports" dated 08/03/12 and 07/18/12 did not contain the time of the procedures. The findings were confirmed in an interview with the Interim Manager of the Critical Care Unit on 08/10/12 at 0945.
H. Review of Patient #9's clinical record on 08/09/12 revealed the "Operative Report and Proc Record" dated 08/02/12 did not contain the time of the procedure. The findings were confirmed in an interview with the Regulatory Officer on 08/10/12 at 0835.
I. Review of Patient #13's clinical record on 08/10/12 revealed the "Operative Report and Proc Record" dated 08/03/12 did not contain the time of the procedure. The findings were confirmed in an interview with the Regulatory Officer on 08/10/12 at 1330.
J. Review of Patient #25's clinical record on 08/09/10 revealed the "Operative Report" dated 08/03/12 and a second "Operative Report" dated 08/03/12 did not contain the time of the procedures. The findings were confirmed in an interview with the Regulatory Officer on 08/10/12 at 0835.
K. Review of Patient #26's clinical record on 08/10/12 revealed the "Operative Report" dated 08/03/12 did not contain the time of the procedure. The findings were confirmed in an interview with the Service Line Administrator for Women's and Children on 08/10/12 at 1330.
L. Review of Patient #28's clinical record on 08/10/12 revealed the "Operative Report and Proc Record" dated 08/02/12 did not contain the time of the procedure. The findings were confirmed in an interview with the Regulatory Officer on 08/10/12 at 1330.
M. Review of Patient #29's clinical record on 08/10/12 revealed the "Operative Report" dated 08/02/12 did not contain the time of the procedure. The findings were confirmed with the Regulatory Officer on 08/10/12 at 1330.
N. Review of Patient #30's clinical record on 08/10/12 revealed the "Operative Report and Proc Record" dated 08/02/12 did not contain the time of the procedure. The findings were confirmed in an interview with the Service Line Administrator for Women's and Children on 08/10/12 at 1330.