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On the days of the Recertification Survey based on observation and interview, the Hospital failed to ensure emergency equipment was available for pediatric use.( Imaging Department)

The findings include:

On 01-18-12 at 1315 a tour was conducted of the Outpatient Imaging Center. Observation of the Emergency equipment revealed there was not an Ambu Bag available for pediatric use. This finding was confirmed with Radiology Technician #10 who explained that the department services children.

On the days of the Recertification Survey based on patient record reviews, interviews, and hospital policy review, Hospital staff failed to ensure adherence to restraint regulations by way of releasing the patient from restraint at the earliest possible time, and the physician signing and dating the restraint order for 1 of 3 open records reviewed for restraints. (Patient #3).


The findings include:


Record review conducted on 1/18/12 at 1126 revealed Patient #3 was admitted to the hospital on 10/20/11, and discharged on 10/22/11 with the diagnosis of Drug Dependency. Review of a physician order written in the Emergency Department (ED) dated 10/20/11 at 2344 showed the physician ordered "place pt. (patient) in 4 points". The patient received Ativan 0.5 mg (milligrams) IV (intravenous) 10/20/11 at 2336, Ativan 1 mg IV on 10/20/11 at 2345, Geodon 10 mg IM (intramuscular) on 10/20/11 at 2350, Ativan 2 mg IV on 10/21/11 at 0028, and and Geodon 10 mg IM on 10/21/11 at 0028 prior to application of restraints. The hospital form identified as "EMERGENCY CENTER WATCH/RESTRAINT FLOW SHEET" dated 10/21/11 showed the restraints were initiated at 0045, but the order had no time recorded to show when the physician ordered the restraints. The section of the form that reads, "behavior required to discontinue the restraint" was blank. The patient's chart showed a physician order dated 10/21/11 at 0230, that reads, "Four point restraints". There was no documentation of requirement for release of restraints. The hospital form, "RESTRAINT FLOWSHEET" dated 10/21/11, showed staff initiated the patient's restraints at 0340 and staff documentation showed the patient's behavior:
A (agitated), S (sleeping), and D (disoriented) at 0340,
A, S, D at 0540,
C (calm), S at 0700,
C, S, at 0900,
C, S at 1100,
C, S, at 1300, and
C at 1330 when the restraints were documented as released.

The History and Physical (H & P) dictated on 10/21/11 by the physician, states, "...HISTORY OF PRESENT ILLNESS...On arrival in the emergency room, the patient was extremely agitated. She was combative. She kept on asking what happened "over and over." She was extremely restless. She was placed in 4-point restraints. She has thus far received a total of 3.5 mg of Ativan in addition to 20 mg of Geodon. At the time of my evaluation, the patient is still extremely lethargic. She will weakly open her eyes, briefly moved her extremities, but overall, she is deeply somnolent. She is to be admitted for evaluation of her presenting complaints." During an interview with the Assistant Manager of the Emergency Department on 1/18/12 at 1215, it was stated that the physician is suppose to date and time the restraint order form.

Facility Policy #IM300.132, titled, "Restraint Use for Adult and Children", revised 1/12, states, "...ORDER CRITERIA: 1. A physician order is required for each specified use of restraint prior to the application of the restraint. 2. In an emergency, a Registered Nurse may initiate restraint use. A telephone or written order is required within 1 hour of the application of emergency restraints; a telephone order must be converted to a written order based on an examination of the patient within 24 hours. 3. Each order must include the type of restraint, reason for restraint, specific start and end date and behavior required for discontinuing the restraint. 4. PRN orders are not acceptable. 5. A restraint may be discontinued before the end time if behavior changed..."
During an interview with the Assistant Manager of the ED on 1/18/12 at 1215, it was stated that the physician is suppose to date and time the restraint order form.

On the days of the Recertification Survey based on clinical record review and interview, the Hospital failed to ensure for 1 of 21 open patient records reviewed, verbal orders were signed by the physician within 48 hours. ( Patient #14)


The findings include:


On 01-18-12 at 1110, record review for Patient #14 revealed a verbal order for Adult Hypoglycemia Standing Orders obtained by the Registered Nurse(RN) on 01-14-12. The physician had not authenticated the verbal order. A verbal order obtained by the RN on 01-09-12 to "Discontinue Ferrous Sulfate 325 milligrams(mg) and start Ferrous Sulfate 300 mg BID (2 times a day)" was not signed by the physician until 01-17-12. The finding was confirmed by RN #9. Review of facility policy, titled, Verbal Orders or Telephone Orders, reads, ".... Verbal and telephone orders must be authenticated by the ordering physician or another practitioner who has hospital privileges and is responsible for the care of the patient within 48 hours....".

On the days of the Recertification Survey based on observation and interview, Hospital staff failed to ensure emergency equipment was available for pediatric use in the Imaging Department. (AMBU BAG)


The findings include:


On 01-18-12 at 1315, Observations during a tour of the Outpatient Imaging Center's emergency equipment revealed the Imaging Department had no pediatric Ambu Bag available for pediatric emergencies. On 1-18-11 at 1320, Radiology Technician #10 verified the department services pediatric patients.