HospitalInspections.org

Based on clinical record review and staff interviews, it was determined that "medical assistants" (unlicensed personnel) at 2 of 4 off-campus primary care premises are administering and/or dispensing medications, a practice not permitted under State requirements.

Findings are as follows:

The State of Rhode Island Rules and Regulations for Licensing of Hospitals (R23-17-HOSP), Section 19.5 states:

"The hospital shall assure that drugs and biologicals are only administered by appropriately licensed professionals, including but not limited to, physicians, nurses, or physician assistants. Medication administration technicians shall not administer drugs or biologicals under any circumstances."

1. An off-campus premises visit was made to Newport Women's Health in Portsmouth on 3/6/14. Interview with two medical assistants at that facility, at approximately 3:00 PM, revealed that 2 of 3 medical assistants routinely dispense medications which include Nuva Ring, Estrace cream and Vagifem cream. These medical assistants also administer injections which include flu vaccine, Depo Provera and Rho Gam. Each of these injections is given intramuscularly; manufacturer's instructions for Depo Provera specifies it should be administered by deep intramuscular injection.

Review of the medical record for Patient ID # 50 confirmed that a Depo Provera injection had been administered by a medical assistant.


2. An off-campus premises visit was made to Jamestown Family Practice on 3/7/14. Interview with facility staff, at approximately 10:00 AM, revealed that 5 of 7 medical assistants employed by the facility routinely administer flu vaccines and routine children's immunizations.

Based on clinical record review, staff interview, and review of hospital policies, it has been determined that the hospital has failed to ensure that verbal orders are used only in emergent situations, and that they are authenticated timely by the physician, for relevant sample patient ID #3.


Findings are as follows:

Review of the hospital policies entitled:

A. "Nursing Medical Record Documentation" states:

Under "Physician Orders":

"All verbal orders must be appropriately signed by a practitioner involved in the care of the patient no later than the end of the next calendar day...Verbal orders will be indicated as 'V.O.' and only honored in emergent situations."

B. "Medical Staff Rules And Regulations" states:

Under "Section E: General Conduct of Care":

Item 2. "Verbal Orders:
e. Except in urgent/emergent situations, verbal orders should not be given or accepted if the practitioner is physically present on the unit and/or has access to a device that permits direct order entry".

C. Administrative Manual "(Responsibilities For) Diagnostic and Therapeutic Orders":

Under "Practitioner Responsibilities":

Item 3. "All verbal orders must be appropriately countersigned in the EMR (Electronic Medical Record) by a practitioner involved in the care of the patient no later than the end of the next calendar day....".

Review of the clinical record for patient ID #3 revealed verbal orders for Total Parenteral Nutrition (TPN) therapy dated 2/22/2014, 2/23/2014 and 2/24/2014. Additionally, a review of the 2/22/2014 verbal order revealed the order was received at 10:00 AM. The verbal order was not countersigned in the EMR by the practitioner until 2/24/2014 at 7:37 AM, which is after the end of the next business day.

During an interview with the Assistant Clinical Manager on 3/4/2014 at approximately 10:00 AM, she was unable to provide evidence that the order was signed timely in the EMR or that the above verbal orders were taken in an emergent situation in accordance with hospital policies.

Based on surveyor observation and staff interview, it has been determined that the hospital has failed to ensure that the physical environment of the Emergency Department is maintained in such a manner so as to assure the safety and well being of patients.

Findings are as follows:

The Emergency Department (ED) is located on the lower level of the Turner Building. During a tour of the ED, with the Director, on 3/5/2014 at approximately 2:15 PM, two (2) bathrooms (G 110 and G 120) were observed in this area. The Director reported that these bathrooms are utilized by all patients. The door was observed to have a locking mechanism only accessible from the inside.

During the tour, 3 staff members, including the Director, were asked to demonstrate how to open the door from the outside and were unable to demonstrate how to do so should an emergent situation arise inside these bathrooms.