HospitalInspections.org

Based on staff interview and clinical record review and observation, the facility failed to timely treat pain levels for 2 of 10 patients reviewed with emergent medical conditons. (Patients # 7 and 9) The facility treated 44,814 emergency room patients in 2013.
Findings include:

On 09/11/13 from 1:15 P.M. to 4:30 P.M. a tour of the facility's emergency department was conducted with the Assistant Chief Nursing Officer, Director of Critical Care Services, and the Clinical Manager. During the tour, the waiting area was observed to be full of patients, the treatment areas each with a patient were divided with walls and entered via a curtain in lieu of a door. No patients were observed waiting in the hallway.

1. The clinical record review for Patient #7 was completed on 09/12/13. The clinical record revealed this 86 yr old patient arrived to the emergency department by ambulance on 08/09/13 at 8:03 P.M. with a chief complaint of abdominal pain and previous abdominal surgery for obstructed small intestine last year. The patient was triaged at 8:03 P.M. and described pain level as 9 out of 10 and moved to bed at 8:12 PM. At 9:23 P.M. described pain as 10 out of 10.
RN advised charge nurse of family concern of wait time and pain mangement. The clinical record revealed a nursing note dated 08/09/13 at 10:10 P.M. that stated the family called their family doctor who called into the ER department at 9:30 P.M. to ask for pain control for the patient.At 10:12 pain level a 10. At 10:32 P.M. the patient's pain was 10 out of 10. Approximately three and a half hours later on 08/09/13 at 11:28 P.M. the patient's pain was still a 10 out of 10. The record revealed at 11:45 P.M. the patient was given one milligram of dilaudid (pain medication) and at 12:44 A.M. the patient's pain was six out of 10.
On 09/11/13 at 3:30 P.M. in an interview, the Chief Nursing Officer, assistant Chief Nursing Officer, and the administrative director of critical services, confirmed the wait times and said that the above should not have happened.

2. The clinical record review for Patient #9 was completed on 09/12/13. The clinical record review revealed Patient #9 was 56 yr old who presented to the emergency department on 09/11/13 at 1:18 PM for a chief complaint of chest pain for the past two days with cough. The discharge diagnosis was right chest wall strain and shingles of right axilla. The clinical record revealed the patient was triaged at 1:25 P.M. and at 1:32 P.M. and had a blood pressure of 162/107 and a pulse of 98 beats per minute. The triage assessment stated the patient rated the pain as 8 out of 10, with 10 being the worst. The patient's pain was assessed again as 8 out of 10 at 3:06 P.M. No other assessments for pain were noted until after the patient received 10 milligrams of morphine at 9:08 P.M., 8 hours later. The patient was discharged at 10:03 PM.
On 09/11/13 at 3:30 P.M. in an interview, the Chief Nursing Officer, assistant Chief Nursing Officer, and the administrative director of critical services, confirmed the wait times.