HospitalInspections.org

Based on record reviews and interview the hospital failed to ensure Physician Credentialing files were kept up to date for 3 of 3 records reviewed. (S3, S6, S7). Findings:

Review of the credentialing file on 01/26/10 at 2:00 p.m. for S3, MD revealed it contained no current Data Bank Query, no documented evidence of annual TB (Tuberculosis) screening, and no documented evidence of current Malpractice Insurance.

Review of the credentialing files on 01/26/10 at 1:50 p.m. for S6, MD revealed the credentialing file contained no re-appointment application, no documented evidence of annual TB (Tuberculosis) screening, and no current CDS (Controlled Dangerous Substance) license.

Review of the credentialing file on 01/26/10 at 1:50 p.m. for S7, MD revealed it contained no current Data Bank Query, no documented evidence of annual TB (Tuberculosis) screening, no current CDS (Controlled Dangerous Substance) license, and no documented evidence of current Malpractice Insurance.

In an interview on 01/26/10 at 2:00 p.m. with S1, Administrator she confirmed these are required components of a complete Physician Credentialing File.

Based on record reviews and interviews the hospital failed to ensure: 1) the physician responsible for the patient's care was notified of signs/symptoms of EPS (extrapyramidal symptoms/adverse medication reaction) upon admit for 1 of 9 sampled patients (#2) or abnormal capillary blood glucose (CBG) readings less than 60 (34, 48, 53) as per the Physician's Insulin Standing Order and Capillary Blood Glucose (CBG) Levels Policy for 1 of 9 sampled patients (#7); and 2) the prn (as needed) medication, (Geodon) had an indication prior to the patient receiving the medication for agitation for 1 of 9 sampled patients. (#7) Findings:

1) Patient #2:
Review of the medical record of #2 on 01/26/10 at 9:00 a.m. revealed "tremors increased" and "facial EPS." This was documented by S5RN at 1700 (5:00 p.m. on 01/20/10, the date of admission.

In an interview on 01/27/10 at 10:05 S5RN confirmed there is no documented evidence of notification of the physician responsible for the care of #2 of the EPS signs/symptoms present upon admission.

In an interview on 01/27/10 at 8:30 a.m. with S3MD he stated that he was not notified of the EPS signs/symptoms present on #2 upon admission.

S3MD further stated that as Medical Director he would expect nursing staff to notify the physician responsible for the care of the patient of these signs/symptoms.

Patient #7:
Review of #7's medical record revealed CBG readings, 39 and 48 (on 1/17/10 at 6:00 pm), and 53 (on 1/22/10 at 5:00 am). There was no documented evidence in Patient #7's medical record that the physician S6, MD was notified of the CBG readings of 39, 48 and/or 53 as per the Physician ' s Insulin Standing Orders and Capillary Blood Glucose (CBG) Levels Policy.

In an interview with S2, DON on 01/27/10 at 10:40 am, she indicated any CBG result less than 60 should be reported to the physician. She reported that the 39 and 48 CBG results were medical emergencies that required immediate physician notification.

S3, MD was interviewed on 01/27/10 at 8:30 am. S3 verified in Patient #7's medical record the he had a 39, 48 and 53 CBG reading. He indicated all CBG readings less than 60 should be reported to the physician. He confirmed there was no documented evidence the physician was notified of the 39, 48 and/or 53 CGB results in the medical record. He indicated the 39 and 48 (1/17/10) CBG readings were medical emergencies that should had been reported to the physician stat in less than 10 minutes.

The Physician's Insulin (standing) Orders read as follows, " ...CBG < 60, give orange juice with 2 packs of sugar (if NPO, give Glucagon 1mg IM). Recheck CBG in 10 minutes. If still < 60, call MD immediately and give one tube of oral Glucose (if NPO, give Glucagon 1 mg IM). If no response from MD within 10 minutes and CBG still < 60, transfer to emergency room ... " .

Review of the policy titled, " NSG-26 Glucometer Method for Obtaining Capillary Blood Glucose (CBG) Levels " , Adopted: August, 2006, Revised: September, 2009 read, " Lo appears, the blood glucose level may be below 40 mg/dl. Repeat procedure and notify MD of abnormal. Record results on CBG monitoring log. Document nursing interventions performed in progress notes ... " .

2) Patient #7:

Review of #7's Physician's Orders, written on 1/21/10 at 1700 (5:00 pm) read as follows, "...Geodon 10 mg (milligrams) IM (intramuscular) BID (two times a day) prn (as needed) ...". Further review revealed Patient #7 was administered Geodon 10 mg on 1/21/10 at 5:35 pm, 1/22/10 at 10:50 am and 3:50 pm, 1/23/10 at 6:30 pm and 1/24/10 at 11:00 am.

S3, MD was interviewed on 01/27/10 at 8:30 am. S3, MD verified #7 was administered Geodon a total of 5 times (1/21, 2 times on 1/22, 1/23, 1/24) for agitation with no clarification from the ordering physician of the indication for use of the Geodon. He reported all medications ordered by a physician should have an indication for its usage, so that the staff knows when to give the patient the ordered medication.

Based on record reviews (medical records, contracted radiology service contract) and interview the hospital failed to ensure the contracted radiology service was in compliance with it's contractural obligation to provide a completed x-ray report with 12 hours for 1 of 9 sampled patients, (#3). Findings:

Review of the medical record for patient #3 on 01/26/10 at 8:45 a.m. revealed an order dated 01/22/10 (no time documented) for an x-ray of the left foot/ankle of #3.

Review of the report generated by the contracted radiology service revealed a service date of 01/24/10, time of service 3:25 p.m., 2 days after being ordered.

Further review of the report generated by the contracted radiology service revealed a report date of 01/24/10 at 4:46 p.m., 2 days after the x-ray was ordered.

This finding was confirmed by S1, Administrator and S2, DON on 01/25/10 at 1:20 p.m.

Review of the contract with the contracted radiology service on 01/25/10 at 1:00 p.m. under "9. Same Day Service" reads in part: "(D) "Service will be provided on a first call basis (Average time of 2 hours) but will always be within 12 hours of the "request for service"....." Under "11. Reports" the contract reads in part: "(A). A "Completed Electronically Signed Report" will be faxed....the final written report will be provided within (12) hours of the initial call for services."