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Based on medical record review and staff interview it was determined the facility failed to ensure nursing reviewed the patient's plan of care daily and kept the care plan current for three (#3, 4, 5) of twelve records reviewed.

Findings include:

1. Review of the medical record for patient #3 revealed the patient was admitted on 3/9/2014 and was a current inpatient. Review of the patient's plan of care revealed nursing initiated the plan on 3/9/2014. Review of nursing documentation revealed no evidence the patient's plan of care was reviewed from 3/14/2014 through 3/17/2014. Interview with the Director of 3 Medical on 3/18/2014 at approximately 10:30 am stated the patient's plan of care is to reviewed by an RN daily. The Director confirmed the patient's plan of care was not reviewed daily.

2. Review of the medical record for patient #4 revealed the patient was admitted on 3/15/2014 and was a current inpatient. Review of the patient's plan of care revealed nursing initiated the plan on 3/15/2014. Review of nursing documentation revealed no evidence the patient's plan of care was reviewed on 3/16/2014. The Director of 3 Medical confirmed the above findings.

3. Review of the medical record for patient #5 revealed the patient was admitted on 3/15/2014 and was a current inpatient. Review of the patient's plan of care revealed nursing initiated the plan on 3/15/2014. Review of the patient's record revealed a culture was positive for MRSA and nursing was notified on 3/17/2014. Review of the patient's plan of care revealed no evidence the care plan reflected the newly identified problem of MRSA and the intervention of contact isolation. The Director of 3 Medical confirmed the patient's plan of care was not updated and current.

Based on review of medical records and staff interview it was determined the facility failed to ensure administration of medication was administered according to the physician's orders and administered in a timely manner for five (#1, 3, 5, 8, 12) of twelve records reviewed.

Findings include:

1. Review of the medical record for patient #1 revealed the patient was admitted to the facility on 2/01/2014. Review of the patient's record revealed on 2/01/2014 the physician ordered Penicillin G 4 million units to be administered IV (Intravenously) every 4 hours.

Review of the patient's MAR (Medication Administration Record) revealed on 2/02/2014 the scheduled 8:00 pm dose of Penicillin G was not administered until 10:11 pm. On 2/03/2014 the scheduled 8:00 am dose of Penicillin G was not administered until 10:00 am. On 2/03/2014 the scheduled 8:00 pm dose was not administered until 10:42 pm. Review of the MAR revealed on 2/04/2014 the 12:00 am scheduled dose of Penicillin G was not administered. Nursing documentation revealed the dose was not administered due to the previous dose being given late. Review of the record revealed the nurse did not notify the ordering physician of the missed dose of antibiotic.

Interview with the Director of 2 West on 3/18/2014 at approximately 2:00 pm confirmed medication should be administered within one hour of the scheduled dose. The Director confirmed the above findings.

2. Review of the medical record for patient #3 revealed te patient was admitted to the facility on 3/09/2014 and was currently an inpatient. Review of the physician orders revealed on 3/09/2014 the physician ordered Zosyn 3.375 grams IV every 6 hours. Review of the MAR revealed on 3/10/2014 the scheduled 12:00 pm dose and 6:00 pm dose were not administered. Review of the record revealed no evidence for not administering the medications. The finding was confirmed with the Director of 3 Medical on 3/18/2014 at approximately 10:30 am.

Review of the physician orders for patient #3 revealed on 3/16/2014 at 7:15 pm an order for a 250 ml (milliliter) Normal Saline IV bolus stat was ordered. Review of the MAR and nursing documentation revealed no evidence the IV bolus was administered as ordered. The finding was confirmed with the Director of 3 Medical on 3/18/2014 at approximately 10:30 am.

3. Review of the medical record for patient #5 revealed the patient was admitted to the facility on 3/15/2014 and was currently an inpatient. Review of the physician orders, dated 3/15/2014 at 12:50 pm, stated to give Vancomycin 1 gram IV every 12 hours with pharmacy to dose. Documentation in the record revealed pharmacy dosed the Vancomycin stating Vancomycin 1 gram IV every 12 hours to begin at 1:00 am. Review of the MAR revealed the Vancomycin was not administered at 1:00 am. Nursing documentation on at 3:00 am stated the medication was not available. Review of the MAR revealed the Vancomycin was given at 11:50 am, more than 10 hours after it was ordered. The finding was confirmed with the Director of 3 Medical on 3/18/2014 at approximately 11:30 am.

4. Review of the medical record for patient #8 revealed the patient was admitted to the facility on 3/17/2014 and was a current inpatient. Review of the physician orders revealed Tramadol 50 mg (milligrams) by mouth twice a day and at bedtime was ordered on 3/17/2014 at 1853. Review of the MAR revealed on 3/17/2014 a scheduled dose of Tramadol 50 mg at 9:00 pm was not administered. Review of the nursing documentation revealed no evidence why the medication was not administered.

Review of the physician orders revealed Quetiapine 200 mg by mouth at bedtime was ordered on 3/17/2014 at 1836. Review of the MAR revealed the schedule 9:00 pm dose on 3/17/2014 was not administered. Review of the nursing documentation revealed no evidence why the medication was not administered. Interview with the Director of 2 West at the time of the above findings on 3/18/2014 at approximately 10:15 am confirmed the findings.

5. Review of the medical record for patient #12 revealed the patient was admitted to the facility on 1/27/2014. Review of the physician orders revealed on 1/31/2014 Daptomycin 400 mg IV every 48 hours. Review of the MAR revealed the scheduled dose on 2/2/2014 at 11:00 am was not administered. Review of the nursing documentation revealed on 2/2/2014 at 5:16 pm the nurse documented the medication has not been available for administration. There was no evidence the nurse notified the pharmacy of the unavailability of the medication and no evidence the physician was notified that the medication was not administered. Review of the MAR revealed the Daptomycin was not administered until 2/4/2014 at 12:19 am.

The Director of 2 West called and spoke with the pharmacist at the time of the finding to verify Daptomycin was available on 2/2/2014. The pharmacist confirmed the medication was available on 2/2/2014. Interview with the Director of 2 West on 3/18/2014 at approximately 3:10 pm confirmed the medication was not administered as ordered.