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Based on interview and record review, the facility failed to ensure nursing staff administered medications under accepted standards of practice for 1 (#6) of 15 patients reviewed for medication administration from a total of 23 sampled patients, resulting in the potential for poor patient outcomes. Findings include:

On 8/2/16 at approximately 1330, review of patient #6's medical record revealed that the patient was a 33 year old male admitted to the facility on 5/14/16 and was discharged on 5/20/16 against medical advice (AMA). The patient's diagnoses included suicidal ideations, hypertension, anxiety and migraines.

A review of physician orders dated 5/15/16 documented the following medications were ordered for the patient:
Qvar inhaler (80) micrograms (mcg) 2 puffs twice per day
Flexeril 10 milligrams (mg) by mouth (po) 3 times per day
Inderal (used to treat angina, high blood pressure, and heart rhythm disorders), 40 mg twice per day (po)
Topamax (used for migraines) 25 mg twice per day (po)
Zoloft 100 (mg) daily (po)
Motrin 800 (mg) 3 times per day

A physician's order (dated 5/18/16) at 0815 documented:
Vistaril (used for anxiety) 50 (mg) 3 times per day as needed anxiety. Do not exceed 150 (mg) per day. Do not give injection. Give by mouth only. No closer than 1/2 hour apart.

A review of the patient's Medication Administration Records (MARS) documented the patient only received Inderal as ordered by the physician on 5/15/16 and 5/16/16. There were no orders in the medical record to hold or discontinue the Inderal. Additionally, the patient only received Topamax as ordered by the physician on 5/15/16 and 5/16/16. There were no orders in the medical record to hold or discontinue the Topamax. There were no notes in the medical record that documented why the patient did not receive the Inderal or Topamax after 5/16/16.

A review of a nurse's note dated 5/20/16 at 0530 documented the patient's: "Chief Problem: 'They won't give me meds'. Current Symptoms: Sweating , short of breath. Current Behaviors: Increased Blood Pressure 147/108. Interventions: Called Medical Doctor. Assessment: Mood: Angry. Significant Information from the Doctor this shift: Informed Medical Doctor of patient's vital signs and Medical Doctor said no medications at this time.
This nurse's note did not specify which medications that the patient had complained about not receiving. The nurse's note did not document if the Medical Doctor was aware of what medications the patient had not received.

On 8/2/16 at approximately 1500 an interview and record review was conducted with the Director of Nursing Staff F. When asked to explain why the patient did not receive his Inderal and Topamax as ordered by the physician Staff F stated she did not know. Staff F confirmed there were no orders to stop or discontinue the medications. When asked to explain why the patient had complained about not receiving his medications on 5/20/16 Staff F stated, "The nurse (Registered Nurse G) who wrote that note is here. She usually works 3rd shift but she is working today. We can ask her."

On 8/2/16 at approximately 1510 during an interview and record review Staff G explained patient #6 had requested Vistaril and she stated, "He had already received his 3 doses on the previous day. It was too early. I called his Doctor and I was instructed not to give him any med's." When asked to clarify what medications were not to be given to the patient Staff G stated, "The Vistaril. It was too early." During a review of the (MAR) with Staff F and Staff G when asked to explain why it would have been too early to have given the patient the "Vistaril", Staff reviewed the (MAR) dated 5/19/16 and 5/20/16 and the order for Vistaril dated (5/18/16) . Staff G stated, "He (#6) had received Vistaril on 5/19/16 at 0135 and 0655 and at 1400 so he'd already received 3 doses in 24 hours. Staff G confirmed the patient had not received Vistaril on 5/20/16. However Staff G offered no further explanation as to why she did not administer the patient the Vistaril as he requested on 5/20/16 almost 6 hours into the new day and over 15 hours since the patient's last dose of Vistaril.

On 8/3/16 at 1100 a review of the facility's "Medication Orders and Administration" policy (dated 2/2014) documented:
Procedures:
"...#10. If a medication is not given for any reason, the reason and time shall be documented in the medical record."

Based on interview and record review, the facility failed to ensure nursing staff transcribed physcian medication orders accurately for 1 (#6) of 15 patients reviewed for medical records from a total of 23 sampled patients, resulting in the potential for poor patient outcomes for all 64 patients serviced by the facility. Findings include:

On 8/2/16 at approximately 1330, review of patient #6's medical record revealed that the patient was a 33 year old male admitted to the facility on 5/14/16 and was discharged on 5/20/16 against medical advice (AMA). The patient's diagnoses included suicidal ideations, hypertension, anxiety and migraines.

A review of physician orders dated 5/15/16 documented the following medications were ordered for the patient:
Qvar inhaler (80) micrograms (mcg) 2 puffs twice per day
Flexeril 10 milligrams (mg) by mouth (po) 3 times per day
Inderal (used to treat angina, high blood pressure, and heart rhythm disorders), 40 mg twice per day (po)
Topamax (used for migraines) 25 mg twice per day (po)
Zoloft 100 (mg) daily (po)
Motrin 800 (mg) 3 times per day

A review of the patient's Medication Administration Records (MARS) documented the patient only received Inderal as ordered by the physician on 5/15/16 and 5/16/16. There were no orders in the medical record to hold or discontinue the Inderal. Additionally, the patient only received Topamax as ordered by the physician on 5/15/16 and 5/16/16. There were no orders in the medical record to hold or discontinue the Topamax. There were no notes in the medical record that documented why the patient did not receive the Inderal or Topamax after 5/16/16.

On 8/2/16 at approximately 1500 an interview and record review was conducted with the Director of Nursing Staff F. When asked to explain why the patient did not receive his Inderal and Topamax as ordered by the physician Staff F stated. "I don't not know. The orders are there. It looks like a transcription error. Staff F confirmed there were no orders to stop or discontinue the medications. Staff explained the midnight Registered Nurse was responsible for making sure the medication transcriptions were accurate.

On 8/3/16 at 1100 a review of the facility's "Medication Orders and Transcibing " policy (dated 8/2015) documented:
Procedures:
"...C. Registered Nurse will: ...2. Verify accuracy of each transcription, checking laboratory orders, consultation sheet, medication sheet, etc. to assue order was properly transcribed...".

"...D. Charge Nurse (Midnight shift 1100 pm-7:30 am) will:
1. Review all charts to assure that orders written in the previous 24 hours have been transcribed accurately."