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Based on review of the documentation, interview, and observation, the facility failed to ensure that medications were administered to the patient in a timely manner for one of four random medication observations passes, Patient #4.

The findings include:

Review of the facility nursing policy for "eMAR documentation" for medication administration revealed "All medication times are listed in military time. Our goal per the CMS guidelines is to administer medications within 30 minutes before and 30 minutes after the scheduled time."

Random observation during the survey process at 9:50 AM on the 3rd floor (telemetry intermediate care unit) revealed the nurse administered 3 medications to Patient #4 at 9:50 AM. The nurse administered Synthroid 50mcg orally, ASA 81mg orally, and Novolin N 30 units subcutaneous. Review of the physician orders in conjunction with the MAR (medication administration record) for this patient revealed Synthroid was to be administered at 7:30 AM; ASA was to be administered at 8:30 AM; and Novolin 30 units was to be administered at 7:30 AM. Interview with the nurse at approximately 10:35 AM revealed he had gotten behind due to another emergency on the unit. He did not tell the nurse manager or director he had gotten behind. The patient's breakfast tray was on the bedside table.
Interview with the Nurse Director of the 3rd floor at approximately 12:17 PM revealed either she or the manager are on the unit at all times or are available, but the nurse did not ask anyone for back up. If he had, they could have helped him. Interview with the Risk Manager and Nurse Manager revealed the patient had completed breakfast prior to the administration of the insulin. Interview with the Chief Nursing Officer (CNO) at approximately 4:20 PM revealed she was aware of the last medication administrator, confirmed the nurse did not call for back up, and the nurse manager or director did not ask the nurse during the emergent situation if he required additional help. The CNO agreed that the manager and director could have stepped in to help.