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Based on interview and record review, it was determined the facility failed to ensure physician's verbal orders were signed in a timely manner for two (2) of nineteen (19) sampled patients. Patient # 1 had two (2) telephone orders in September 2010 that had not been signed by the patient's physician. Patient #2 had four (4) telephone orders which had been signed six (6) to eleven (11) days after the facility received the orders.

The findings include:

A review of the closed medical record for patient #1 conducted on November 23, 2010, revealed the patient had been admitted to the facility on September 12, 2010, with a diagnosis of Chronic Obstructive Pulmonary Disease Exacerbation. A review of the record revealed the facility received a physician's telephone order on September 25, 2010 and on September 26, 2010, for soft restraints to be applied to patient #1. The patient's record further revealed the orders had never been signed by the physician.

A review of the closed medical record for patient #2 conducted on November 23, 2010, revealed the patient had been admitted to the facility on October 18, 2010, with diagnoses to include Neck Mass and Dysphagia. The facility received a physician's telephone order on October 18, 2010, for ventilator orders to titrate the FIO2 to keep patient #2's oxygen saturation levels greater than 94 percent. According to the medical record, the order was signed electronically on October 25, 2010, seven days after the order was obtained.

Further review of patient #2's medical record revealed a physician's telephone order dated October 18, 2010, for a Foley catheter, restraints to keep the patient from pulling out intravenous lines, the patient's tracheostomy tube, and for a CAT Scan of the abdomen and chest. According to the medical record the orders were electronically signed by the physician on October 29, 2010, 11 days after the orders were obtained.

The medical record further revealed a physician's telephone order for patient #2 on October 19, 2010, to transfer the patient to the University of Kentucky Medical Center by helicopter. The physician's order was signed electronically on October 25, 2010.

A review of the facility's policy titled Verbal Orders dated February 2010 revealed the policy did not specify a timeframe by which a physician's verbal or telephone orders must be signed by the ordering physician.

An interview conducted with the Director of Nursing Services (DON) on November 23, 2010, at 5:50 p.m., revealed the facility required physicians to sign verbal or telephone orders within 48 hours after the facility received the order.

This CONDITION is not met as evidenced by:

Based on observation, interview and record review it was determined the Condition of Participation: Physical Environment was not met. The facility failed to maintain the physical environment to ensure the safety and well-being of patients. Life Safety Code, 42 CFR 483.70, deficiencies were cited that determined the Condition of Participation for Physical Environment at 42 CFR 482.41 was not met. Refer to tags K052, K054, K072 and K144.

Based on observations, interviews, and a review of policies/procedures, the facility failed to ensure that policies/procedures had been developed and implemented to maintain a safe and sanitary environment.

The findings include:

Observations conducted and reviews of medical records on the medical/surgical nursing unit of the facility on November 23, 2010, revealed facility staff utilized individual, hard plastic binders to store medical information and/or reports for each individual patient during the patient's hospitalization. Observation of the individual, hard plastic binders revealed the surface of the binders had a heavy buildup of dirt/residue and adhesive.

Interview with the Assistant Director of Nursing (ADON) on November 23, 2010, at 1:00 p.m., revealed the facility did not have an established policy/procedure for the cleaning of the plastic binders and stated the Unit Secretary was to cleanse the binders with a sanitizer at the time of the patient's discharge from the facility. The ADON acknowledged there was not a designated staff person or schedule maintained for the thorough cleansing of the plastic binders to remove the heavy buildup of dirt/residue and adhesive.

Interview with the Unit Secretary on November 23, 2010, at 3:40 p.m., revealed the secretary's responsibilities included answering the telephone, transcribing physician's orders, stocking supplies on the unit, and to answer patient call lights as needed. The secretary acknowledged that at the time a patient was discharged from the facility the plastic binders were wiped with a sanitizing solution, but were not thoroughly cleansed to remove the buildup of dirt/residue and adhesive.

A review of the facility's infection control program revealed the facility had established policies related to infection control and the surveillance of infections throughout the facility. However, interview with the Chief Clinical Officer (CCO) on November 23, 2010, at 6:45 p.m., and a review of policies/procedures revealed the facility had failed to establish a policy/procedure for the thorough cleansing of each plastic binder that held individual patient information and that was utilized by facility staff in the documentation of patient care.