HospitalInspections.org

Based on review of documents and staff interview, the consulting Ear, Nose and Throat (ENT) physician failed to respond to a consultation request within the time limits allotted for routine consultations (twenty-four (24) hours) in accordance with the Medical Staff Rules and Regulations. This has the potential to limit the quality of patient care. Findings include:

1. Review of the Medical Staff Bylaws/Rules and Regulations (dated 9/2009) revealed on page 9 the following: "routine consults should be answered within 24 hours".

2. Upon interview with the CEO on 3/18/10 in the morning, she stated the hospital utilitizes the Emergency room specialist on call schedule as a specialist on call schedule for the care of inpatients.

3. The "Physician's Orders and Signature" sheet (patient number one on the identifier list) indicated on 2/6/10 the attending physician (v) ordered an ENT consultation regarding a "mass" in the patient's throat. The attending physician requested the ENT consultation to be completed on 2/8/10 as no ENT specialists were on-call for 2/6-7/10. The medical record indicated the ENT Specialist performed his ENT consultation three days later on 2/11/10, the day of discharge. During his consultation for a "mass..... in the patient's soft palate"; he removed (with a hemostat) a partial lower denture caught in the patient's throat.

4. Review of the physician's call schedule (dated February 2010) revealed an ENT physician was not on-call for February 6 -7, but was on-call for February 8-11/ 2010.

5. During interview with the Risk Manager and the Director of Quality Assurance /Performance Improvement on 3/16/10 in the a.m., they both agreed the ENT Specialist did not perform his consultation within the twenty-four (24) hour limit as stipulated in the Medical Staff Rules and Regulations. The consultation was performed the day of discharge which was three (3) days after the request was made.

Based on document review, medical record review and staff interview, the hospital failed to ensure the nursing staff administers patient medications as ordered by the physician, and per hospital policy, in five (5) of seven (7) closed medical records (Patients #1, 2, 5, 6, 7) reviewed. This has the potential to negatively impact all patient care by patients receiving an overdosage or underdosage of medication. Findings include:

1. Raleigh General Hospital policy Medication Dispensing and Administration, effective 2/07, states in part "...IV. Electronic Medication Administration Records (eMARs): V. Medication Administration Times: B. Every effort should be made to administer the medication within an hour before or after the designated time. Miscellaneous STAT/NOW To be given within thirty (30) minutes of order..."

2. Review of the medical record for Patient #1 revealed twenty-seven (27) medications were administered more than one (1) hour past the scheduled time, seven (7) medications were administered more than one (1) hour before the scheduled time and one (1) NOW/STAT medication was administered more than thirty (30) minutes after the order between the dates of 1/29/10 and 2/8/10.

3. Review of the medical record for Patient #2 revealed three (3) medications were given more than one (1) hour past the scheduled time and one (1) medication was given more than one (1) hour before the scheduled time on 2/9/10.

4. Review of the medical record for Patient #5 revealed two (2) medications were given more than one (1) hour past the scheduled time on 2/3/10.

5. Review of the medical record for Patient #6 revealed six (6) medications were given more than one (1) hour past the scheduled time on 2/6/10.

6. Review of the medical record for Patient #7 revealed three (3) medications were given more than one (1) hour past the scheduled time and five (5) medications were given more than one (1) hour before the scheduled time between the dates of 2/10/10 and 2/12/10.

7. During an interview with the Nurse Manager (NM) of 2-North (2N) in the afternoon of 3/17/10, the NM reviewed the patient medical records and agreed with the above findings.