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Based on review of four (Pt. #1, #2, #3 and #5) of 10 patient records, the facility failed to ensure the nursing staff followed the Hospital's medication reconciliation process.

Findings include:

The Hospital's Medication Reconciliation Policy indicated that in the Emergency Department (ED) a licensed nurse or other licensed staff member during the intake process shall obtain a list of pre-hospital medications. If the patient or family have a copy of the medications, the list should have a patient identification label affixed to the medication list. The list then shall be stapled to the Medication Reconciliation Current (pre-hospital) List and reviewed with the patient/family and changes will be documented. The completed Medication Reconciliation Form will be scanned/faxed to the pharmacy and the date and time of the fax should be placed on the form. The policy and procedure also indicated that the completed Medication Reconciliation Form form should be reviewed, signed, dated and timed by the admitting nurse attesting to its accuracy and completeness.

Pt. #1's medication reconciliation Current Medication List Form, dated 9/13/12, indicated that the Form was not faxed to the Pharmacy when he/she was admitted to the Hospital as required by Hospital policy and procedure. The admitting nurse failed to document she reviewed Pt. #1's medication list with Pt. #1 and or his/her family as required by Hospital policy and procedures and completed the medication reconciliation process.

Pt #2's Medication Reconciliation Current (Pre-Hospital) Medication List Form, dated 9/12/12, indicated that the Form was not faxed to the Pharmacy as required by Hospital policy and procedure.

Pt #3's Medication Reconciliation Current (Pre-Hospital) Medication List Form, dated 8/15/12, indicated that the faxed list was not dated and timed as required by Hospital policy and procedure.

Pt #5's Medication Reconciliation Current (Pre-Hospital) Medication List Form, dated 10/5/12 indicated that the list was not faxed to the Pharmacy. The spaces on the form for date and time were blank.

Based on observations and record review the Hospital failed to ensure the nursing staff followed the policy related to Intravenous (IV) therapy.

The Hospital's policy and procedure indicated that all peripheral IV primary administration sets are changed every 72 hours. Primary secondary intermittent administration sets shall be changed every 24 hours. All IV tubing shall be labeled with a registered nurses (RN) initials, the date and time the tubing was hung and when the tubing expires. IV fluids will be labeled with a RN's initials and labeled with a patient name, the additives to the IV fluid, the date and time the IV fluid was hung.

During observation of a medication pass conducted on 10/9/12 at 8:30 A.M. revealed that Pt. #3's IV tubing was not dated and timed as required by Hospital policy and procedure. The label on the bag of IV fluid identified only Pt. #4's name. The label was not completed according to Hospital policy.

Based on interviews and record review the Hospital failed to ensure that the listing of facilities used by the Hospital as referral sources was provided for one of ten (Pt. #3) patient records reviewed.

Findings include:

During a tour of the medical/surgical unit conducted on 10/11/12 at 10:30 A.M. a case manager (Case Manager #2) was interviewed. Case Manager #2 said she verbally reviewed with Pt. #3 the skilled nursing facilities that were based on Pt. #3's insurance and where Pt. #3's attending physician had admitting privileges. Case Manager #2 said she did not document or provide in writing the list to Pt. #3 or his/her family.

Pt. #3 was interviewed on 10/11/12, during the tour of the Medical/Surgical Unit. Pt. #3 said he/she was preparing for discharge and did not want to return to the skilled nursing facility. Pt. #3 said he/she was not provided a list of other skilled nursing facilities.

Based on one of ten (Pt. #1) patient records reviewed, the Hospital failed to ensure accurate prescription medication was prescribed for Pt. #1 when he/she was transferred from the Hospital to the skilled nursing facility (SNF), resulting in Pt. #1 receiving those medications which caused him/her to become unresponsive and required an acute transfer from the SNF to the Hospital.

Findings include:

The Hospital's Internal Investigation regarding Pt. #1 and Pt. #1's Discharge Medication Reconciliation Form, dated 9/18/12 indicated that 12 additional prescriptions were transcribed from another patients home medication list (that was incorrectly labeled and placed in Pt. #1's medical record) to prescribed discharge prescriptions that were inaccurate.