HospitalInspections.org

Based on closed medical record review, medication prescribing information and interview, the facility failed to ensure medication was administered in the appropriate form for 1 of 3 (Patient #1) sampled patients.

The findings included:

Medical record review for Patient #1 revealed a Discharge Summary documenting the patient was admitted to the hospital 12/26/16 with diagnoses including Bipolar disorder. The patient was discharged from the hospital 1/3/17.
The Discharge Summary documented, "...CURRENT HOME MEDICATIONS: Depakote ER 500 mg [milligrams] at bedtime... HOSPITAL COURSE:...Her Depakote was decreased to 250 mg at bedtime..."

The patient's Medication Administration Record (MAR) documented, "...divalproex sodium DRT 500 mg...Oral AT BEDTIME for Depression..." and documented it was given 12/26/16 at 9:44 PM, and was discontinued 12/27/16 at 9:02 PM. The MAR documented, "...divalproex sodium DRT 250 mg Oral AT BEDTIME To give 250 mg use 0.5 ea of 500 mg for Depression..." The MAR documented it was given 12/27/16 through 1/2/17 between 8:46 PM and 9:47 PM.

Review of Drugs.com FDA prescribing information for Divalproex revealed, "...Generic Name: Divalproex sodium Dosage Form: tablet, delayed release...Divalproex Dosage and Administration...Divalproex sodium delayed release tablets should be swallowed whole and should not be crushed or chewed..."

During an interview with the Chief Nursing Officer on 2/7/17 at 4:00 PM in the CEO's office, the Chief Nursing Officer stated the facility has an in-house pharmacy, Depakote DRT is different from Depakote Extended Release. She also stated, the patient's Depakote DRT was cut in half by the pharmacy prior to delivery to the patient floor.