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Based on medical record review and interview the facility failed to ensure that physician's medication orders were clarified for 1 of 4 patients (#1), as per the facility's policy and procedure. The facility failure to ensure the physician's orders for medications were timed and clarified can lead to medication errors.

Findings:

During medical record review for Patient #1 it was revealed that on 2/17/10 at 4:14 PM the physician ordered the following medication: Keppra 750 milligrams (mg), with instructions to give one dose at 5-6 PM prior to discharge, and Keppra 500 mg by mouth twice a day start 2/18/10. On 2/17/10 at 5:20 PM the physician ordered the following medication: Dilantin 300 mg by mouth three times a day, Phenergan 25 mg oral daily as needed, Keppra 750 mg oral twice a day, Valium 10 mg oral four times a day and Lortab 7.5 mg daily as needed. It was noted that the previous Keppra 500 mg order was not discontinued.

Interview of the Pharmacy Director on 4/5/10 at 1 PM stated that he would have questioned the two orders for Keppra (Keppra 500 mg and Keppra 750 mg). He stated that he would have asked that they be clarified.

On 4/5/10 1:30 PM interview of the Pharmacist who filled the medication ordered stated that she felt that the second Keppra order superseded the first order therefore the Keppra 750 mg was actually dispensed.

Interview of the Pharmacy Director on 4/5/10 at 2 PM stated that there are no policies which state that orders supersede each other. He stated that the order needed to be clarified and the doctors should date and time the orders when written per hospital policy.

Review of facility policy labeled "Drug Orders" on page 2 under "Clarification of Orders" states that Drugs shall not be dispensed or administered pursuant to an order that is illegible, unclear or incomplete."

Based on medical record review and interview the facility failed to ensure that physician's medication orders were timed for 2 of 4 (#2 and #3) patients and that medication orders were clarified for 1 of 4 patients (#1). The facility failure to ensure the physician's orders for medications were timed and clarified can lead to medication errors.

Findings:

During medical record review for Patient #1 it was revealed that on 2/17/10 at 4:14 PM the physician ordered the following medication: Keppra 750 milligrams (mg), with instructions to give one dose at 5-6 PM prior to discharge, and Keppra 500 mg by mouth twice a day start 2/18/10. On 2/17/10 at 5:20 PM the physician ordered the following medication: Dilantin 300 mg by mouth three times a day, Phenergan 25 mg oral daily as needed, Keppra 750 mg oral twice a day, Valium 10 mg oral four times a day and Lortab 7.5 mg daily as needed. It was noted that the previous Keppra 500 mg order was not discontinued.

Interview of the Pharmacy Director on 4/5/10 at 1 PM stated that he would have questioned the two orders for Keppra (Keppra 500 mg and Keppra 750 mg). He stated that he would have asked that they be clarified.

On 4/5/10 1:30 PM interview of the Pharmacist who filled the medication ordered stated that she felt that the second Keppra order superseded the first order therefore the Keppra 750 mg was actually dispensed.

Interview of the Pharmacy Director on 4/5/10 at 2 PM stated that there are no policies which state that orders supersede each other. He stated that the order needed to be clarified and the doctors should date and time the orders when written per hospital policy.

Review of facility policy labeled "Drug Orders" on page 2 under "Clarification of Orders" states that Drugs shall not be dispensed or administered pursuant to an order that is illegible, unclear or incomplete."

During medical record review for Patient #2 it was noted on 4/3/10 the physician's ordered the following medication: change Lasix to 40 mg by mouth in morning and 20 mg by mouth every evening, and 0.9% Normal Saline at 50 milliliter (ml)/hour. The order was signed and dated but no time was listed.

During medical record review for Patient #3 it was noted that on 4/5/10 the physician ordered Protonix 40 mg by mouth daily no substitutions. The order was dated and signed but no time was listed.