HospitalInspections.org

Based on review of clinical records and staff interview, the facility failed to ensure information relating to drug information were available to the professional staff.

Findings included:

Review of the Texas Administrative Code (TAC), Title 22, Part 15, Chapter 291, Subchapter D, Rule §291.74(g)(B) stated in part, "(i) For the purpose of promoting therapeutic appropriateness, a pharmacist shall evaluate medication orders and patient medication records for: ...(II) rational therapy-contraindications;
...(VIII) Drug-disease interactions."

The package insert for haloperidol [the generic name for Haldol] stated in part, "Haloperidol is contraindicated in severe toxic central nervous system depression or comatose states from any cause and in individuals who are hypersensitive to this drug or have Parkinson's disease."

Review of patient #1's medical record revealed a neurology consult dated 6/4/17 at 11:37 pm that stated in part, " ...is consulted to neurology for suspected Parkinson's disease. Patient on exam does have findings consistent with Parkinson's ..." Patient #1 was started on medications for Parkinson's and Parkinson's was added as a diagnosis.

An order dated 6/6/17 at 2:15 am for haloperidol lactate 5 mg [milligrams]/ml [milliliter] vial stated in part, "Instructions and comments ... Nov 2007
A recent FDA [Food and Drug Administration] alert, along with new labeling, warns health professionals about the possibility of QT prolongation and Torsades de Pointes in patients treated with the antipsychotic drug Haldol ..." This comment was about 10 years old and had no warning about the contraindication of Parkinson's disease.

In an interview with staff #8 on the afternoon of 6/21/17, staff #8 stated, "The alert that fired [in the computer system] for this medication talked about QT prolongation, it did not discuss Parkinson's at all ... The diagnosis [for this patient] is still 'acute respiratory distress ...' It's not populating the Parkinson's on the banner that pharmacy sees ... Parkinson's is an absolute contraindication for Haldol. So is IV [intravenous] use, but we still give it."

The nursing and pharmacy staff were unaware of the absolute contraindication of Parkinson's with Haldol at the time of administration to patient #1.

The above was verified in an interview with the CNO and other administrative staff on the afternoon of 6/21/17.