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Based on interview and record review, the facility failed to follow written policies and procedures regarding the visitation restriction for 1 (SP#1) of 3 sample patient (SP).

Findings include:

Review of COVID-19 Visitor Policy dated 09/21/2021 documented patients are limited to one adult (age 16 and over) visitor at a time.

Review of SP#1 Designation of Healthcare Proxy dated 08/31/2021 at 10:00PM documented an adult child of the patient was assigned to make healthcare decisions.

Interview with Vice President Quality on 11/19/2021 at 12:00PM revealed on 10/23/2021 at 2:00PM the family member of SP#1 continued to make verbal threats towards staff.

Review of SP#1 Nurse Notes dated 10/27/2021 at 4:37PM documented call placed to SP#1 family member, in the presence of Vice President Quality, Director of Patient Safety, Director of Security and Director Intensive Care Unit, to discuss from this point forward visitation is suspended. SP#1 family member was instructed that the physician from the care team would be calling with updates as to the patient's condition and any change in condition.

Review of SP#1 Nurse Notes dated 10/28/2021 at 12:39PM documented call placed to SP#1 family member. SP#1 family member requested email stating "that (family member) is not allowed to visit so (family member) can appeal." Director of Security reiterated to SP#1 family member that visitation remains suspended and SP#1 family member may not come into the hospital and an email will not be sent.

Review of SP#1 Nurse Notes dated 10/29/2021 at 12:27PM documented SP#1 family member requesting to visit but due to threats made to staff, visitation remains restricted.

Review of SP#1 Nurse Notes dated 11/03/2021 at 6:02PM documented SP#1 family member requesting videoconference with administration to "plead case for visitation."

Review of SP#1 Death Summary Note dated 11/11/2021 at 1:15AM documented pronouncement of death date: 11/11/2021, time: 1:09AM. SP#1 family member was called twice and message for call back was left shortly thereafter.

Review of the Patient Rights Policy, Effective 01/01/2020, documented all patients have the right and authority to designate who may or may not visit including, but not limited to, another family member.

Review of the Trespass Warning Policy, Last reviewed: 08/2018, documented a Trespass Warning will be issued to those persons that are deemed a danger or threat to employees, patients, visitors and/or medical staff.

The facility did not provide a Trespass Warning to SP#1 family member and denied visitation to SP#1.

The facility did not allow visitation to SP#1s family member.

Based on observation, interview and record review, the facility failed to promote safety in the preparation and administration of drugs. Each medication was not administered separately via percutaneous endoscopic gastrostomy (PEG) tube and flushed with water before and after use in accordance with the administration instructions and standards of nursing practice for 1 (SP#2) of 3 sampled patients (SP); the facility also failed verify PEG tube placement prior to medication administration in accordance with the administration instructions and standards of nursing practice for 1 (SP#2) of 3 sample patients.

Findings include:

Review of the Physician orders for SP#2 dated 11/19/2021 at 11:25 a.m. documented the following medications scheduled for administration via the percutaneous endoscopic gastrostomy (PEG) tube.

Sertraline HCl 25mg tablet daily via feeding tube,
Gabapentin 100mg capsule twice daily via feeding tube

Medication administration observation of SP#2 on 11/19/2021 at 11:33 a.m. revealed, Staff A, Registered Nurse(RN) combined both crushed scheduled medications in a Styrofoam cup and poured an unmeasured amount of water to dissolve medications. The medications were administered via percutaneous endoscopic gastrostomy (PEG) tube and the (PEG) tube was flushed immediately with an unmeasured amount of water.

Interview with Staff B, Nurse Manager, on 11/19/2021 at 11:39 a.m. revealed, when patients come from another facility with a percutaneous endoscopic gastrostomy (PEG) tube and have multiple medications, all medications can be crushed and administered together.

Review of the Nursing Procedures Manual last revised 08/18 documented:
OBJECTIVE: To provide guidelines for nursing staff to carry out safe nursing practice and promote patient safety.
SCOPE: Nursing Department
POLICY: Aventura Hospital and Medical Center adopts the {E...} Nursing Procedures Manual based on current recommended evidence based nursing practice.

Review of the Nursing Procedure steps for Administering Capsules and Tablets through Enteral Feeding Tubes documented:

(1) Prepare each medication one at a time to reduce the risk for error. Do not combine medications when crushing or dissolving.
(2) Do Not mix different medications due to the risk of possible physical chemical incompatibilities, altered drug reaction, or tube obstruction.

Review of the Nursing Procedure steps for Administering Medications Through an Enteral Feeding Tube documented:

(1) Verify Enteral Feeding Tube (EFT) placement prior to medication administration according to unit specific/facility protocol.

Interview with the Associate Chief Nursing Officer on 11/19/2021 at 3 p.m. revealed, the medication administration via percutaneous endoscopic gastrostomy (PEG) tube was not performed according to current policy and procedures. and PEG tube placement was not verified.