HospitalInspections.org

Based on record review and interview, the Hospital failed to ensure that the staff followed the PRN (as needed) Medication Range Orders Policy for one of one sampled patient (Patient).

Findings included:

The Physician was interviewed on 2/2/10, at 1:15 P.M. The Physician said on 12/19/09, the Patient pulled out his indwelling catheter at the Facility, had bleeding, and was admitted to the Facility on 12/19/09.

The PRN Medications Range Orders Policy indicated that the dose of an opioid analgesic medication was to be selected on the assessment of the severity of the pain, using the 0 to 10 pain scale (0 being no pain and 10 being severe pain). The Policy indicated that when 2 dose ranges were ordered, the patient was to be given the lowest dose for mild pain (1-4) and the upper dose for moderate to severe pain (5-10).

The physician order sheet, dated 12/20/09, at 8:45 P.M., included the narcotic pain medication, Vicodin, 1 to 2 tablets every 8 hours as needed (prn) for pain.

There was no documentation in the clinical record, dated 12/20/09, regarding the Patient's pain assessment or pain rating.

The Medication Administration Report, dated 12/20/09, indicated that the Patient received Vicodin 1 tablet at 9:01 P.M.

The physician order sheet, dated 12/22/09, included: discontinue Vicodin and start the narcotic pain medication Dilaudid, 0.5 to 1 mg every 4 hours prn for pain.

The Medication Administration Report, dated 12/22/09, indicated that the Patient received Dilaudid 0.5 mg at 4:50 P.M.

The Medication Administration Report, dated 12/22/09, indicated that the Patient received Dilaudid 0.5 mg at 9:48 P.M.

The Medication Administration Report, dated 12/23/09, indicated that the Patient received Dilaudid 1.0 mg at 3:12 A.M.

The Nurse Manager was interviewed on 2/2/10, at 10:30 A.M. The Nurse Manager said the staff were to assess and rate a patient's pain, administer pain medication per the PRN Medications Range Orders Policy, and then within an hour reassess and rate a patient's pain. The Nurse Manager said although the nurses assessed and documented the Patient's pain symptoms, the nurses did not rate the pain and administer prn pain medication per the PRN Medications Range Orders Policy.

Based on record review and interview, the Hospital failed to ensure for one of one sampled patient (Patient) that the receiving Facility had information regarding the Patient's allergy to the narcotic pain medication, morphine.

Findings included:

The Hospital clinical record indicated that the Patient was admitted to the Hospital on 12/14/09.

The physician order sheet, dated 2/17/10, included morphine 2 milligrams (mg) by intravenous every two hours as needed (prn) for pain.

The Pharmacy Medication Record, indicated that the Patient received morphine 2 mg on 12/17/09, at 9:08 A.M.

The Vital Sign sheet, dated 12/17/09, at 12:05 P.M. indicated that the Patient's blood pressure was 66/32; the Patient was placed in Trendelenburg position, and at 12:35 P.M., the Patient's blood pressure increased to 110/50.

The physician order sheet, dated 12/17/09, at 12:55 P.M., indicated that the Patient had a low blood pressure and was to receive 1 liter of intravenous fluids.

The Pharmacy Medication Record, indicated that the Patient received morphine 2 mg on 12/18/09, at 6:51 A.M.

The physician order sheet, dated 12/18/09, included: discontinue the morphine.

The Physician was interviewed on 2/2/10, at 1:15 P.M. The Physician said on 12/17/09, the Patient's blood pressure decreased possibly due to morphine or dehydration. The Physician said the Patient received intravenous fluids and the Patient's blood pressure improved. The Physician said on 12/18/09, an order was written for the Patient to avoid morphine; the Patient was stable, the Patient's fentanyl patch (narcotic pain medication) was increased to 75 micrograms (mcg) every 72 hours, and the Patient was discharged shortly afterward to the Facility.

The Hospital Transfer Summary, dated 12/18/09, indicated that the Patient was admitted with severe low back pain; the Patient had post void residuals; an indwelling catheter was inserted; the Patient had a hypotensive spell, perhaps from morphine or a poor oral intake, and the Patient received 1 liter of intravenous fluids. The Hospital Transfer Summary indicated that the Patient's fentanyl patch was increased to 75 mc).

The Physician said although the Hospital Transfer Summary indicated that the Patient had delirium due to possible dehydration or morphine, the morphine allergy was not listed on the paperwork that was sent with the Patient to the Facility.