HospitalInspections.org

Based on medical record review, staff interview and review of the facility's policies and procedures, the facility failed to ensure nurses applied sequential compression devices per physician orders for one (Patient #9) out of 10 medical records reviewed. This had the potential to affect all patients receiving services at the facility. The census at the time of survey was 228.

Findings include:

The record review for Patient #9 revealed a history and physical (H&P) completed on 03/31/17. The H&P revealed Patient #9 was admitted to the facility on 03/31/17 with a complaint of shortness of breath and weakness and with a medical history of right lung cancer and deep venous thrombosis ( DVT, a blood clot). Patient #9 was admitted on 03/31/17 with a diagnosis of respiratory failure. The H&P further revealed the patient was intubated and placed on ventilator support upon admission. The H&P revealed due to the patient's history of DVT, he was to be placed on sequential compression device (SCD) boots and to hold anticoagulant therapy.

The medical record review further revealed a physician order dated 03/31/17 for Intermittent Pneumatic Compression to bilateral legs while in bed.

The medical record review lacked evidence of any antiembolism device treatment from 04/1/17 4:00 AM through 04/02/17 8:00 AM.

This finding was confirmed by Staff E on 04/05/17 at 10:12 AM. The record review further revealed the patient remains intubated and on bedrest.

Review of the procedure provided by the facility for Sequential Compression Therapy (Lippincott Procedures revised 08/12/16) was completed. The procedure stated "the compression sleeves should function continuously (24 hours daily) until the patient is fully ambulatory".

Based on policy review, medical record review and staff interview, the facility failed to follow physician orders for the administration of oxygen for one (Patient # 6) out of 10 medical records reviewed. This had the potential to affect all patients receiving services at the facility. The census at the time of survey was 228.

Findings include:

Review of the facility policy titled "Medication Administration and Self Administration Guidelines" (revised 10/17/14) was completed. The policy stated "medication must be ordered by a licensed independent practitioner (Physician, Advanced Nurse Practitioner or Physician Assistant) prior to admission".

Review of the medical record for Patient #6 revealed a history and physical (H&P) completed on 04/03/17. Review of the H&P revealed Patient #6 was admitted on 04/03/17 with a complaint of chest pain and shortness of breath. The H&P revealed Patient #6 had a medical history of chronic obstructive pulmonary disease (COPD) and used Oxygen at three liters/min at home. The admitting diagnoses were myocardial infarction and COPD.

Review of the medical record further revealed physician orders dated 04/03/17 at 7:12 AM for Oxygen at two liters/ minute per nasal cannula. The orders contained no parameters to adjust the oxygen per pulse oximetry readings to maintain a certain oxygen saturation. On 04/03/17 at 7:12 AM the order was changed to oxygen five liters/ minute per nasal cannula. The new orders contained no parameters to adjust the Oxygen per pulse oximetry readings to maintain a certain Oxygen saturation.

The medical record review further revealed nursing documentation on 04/03/17 from 9:00 AM through 11:00 PM of oxygen being delivered at four liters /minute per nasal cannula.

In an interview on 4/05/17 at 9:50 AM, Staff F confirmed there was no order to administer Oxygen at four liters.