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Based on interviews and document review, the facility failed to provide nursing staff to meet patients' needs and care. The facility failed to ensure nursing care was provided in accordance with acceptable standards of practice during medication administration.

This failure created delays in medications administration which could change or impact the intended therapeutic or pharmacological effect of the prescribed medication.

FINDINGS:

POLICY

According to the policy, Medication Management: Administration, non-time-critical medications will be administered within 1 hour before or after the scheduled dosing time, for a total window of 2 hours. These are medications for which a longer or shorter interval of time since the prior dose does not significantly change the medication's therapeutic effect.

Time-critical medications will be administered within 30 minutes before or after the scheduled dosing time, for a total window of 1 hour. These are medications for which an early or late administration of greater than thirty minutes may have significant impact on the therapeutic or pharmacological effect. Medications/medication classes that apply include: any medication prescribed more frequently than every 4 hours, anticonvulsant's (scheduled), immune agents (scheduled), pain medication (scheduled).

1. The facility failed to ensure patients received their scheduled medications within the appropriate time frame.

a) On 06/02/16 at 7:48 a.m., an interview was conducted with Registered Nurse (RN) #1 who stated the RN to patient ratio on the East unit of the Adult Behavioral Unit was high at nights. RN #1 stated the prior week, s/he was assigned to 14 patients, which resulted in patients receiving his/her medications after the scheduled time frame.

b) On 06/02/16 at 9:40 a.m., an interview was conducted with RN #2 who worked in the Adult Behavioral Unit during the day shift. RN #2 stated, although s/he worked the day shift, s/he noticed the night shift was frequently short staffed RNs, specifically the east unit.

c) Review of staffing for the night shift on 05/23/16, revealed RN #1 was assigned for the care of 13 patients on the East Unit. Two of the 13 patients' Medication Administration Records (MARs) were reviewed and showed scheduled medications were given outside of the time frame allowed per policy. Patient A was scheduled to be given 2 non-time-critical medications at bedtime, 09:00 p.m. Both medications were documented as given by another RN assigned to the West Unit, approximately 28 minutes past the 1 hour time frame allowed by policy. Patient B was scheduled 3 medications at 9:00 p.m. One of the medications was a time-critical medication, Lamictal, which was an antiseizure medication. RN #1 documented the medication was given 1 hour and 30 minutes after the scheduled time frame. This was in contrast to policy.

d) Review of staffing for the night shift on 05/26/16, revealed Registered Nurse (RN #3) was assigned for the care of 14 patients on the East Unit. Two of the 14 patients Medication Administration Records (MARs) dated 05/26/16 were reviewed and showed scheduled medications were given outside of the time frame allowed per policy. Patient A was scheduled to have been given a non-time-critical medication at bedtime, 9:00 p.m. RN #3 documented the medication was given at 10:28 p.m., which was 28 minutes after the 1 hour time frame allowed. Patient B was scheduled to have been given 2 non-time-critical medications and 1 time-critical medication at bedtime. All 3 medications were given outside of the time allowed according to policy. The time-critical medication, Depakote, which was given to prevent seizures, should have been given within 30 minutes prior to or after 9:00 p.m. RN # 3 documented the medication was given at 10:05 p.m.

e) Review of staffing for the night shift on 05/27/16, revealed RN #4 was assigned for the care of 11 patients on the East Unit. Two of the 11 patients' MARs were reviewed and showed Patient B was scheduled to be given 1 non-time-critical medication at 9:00 p.m.. RN #4 documented the medication was given at 10:19 p.m. This was in contrast to policy.

f) On 06/02/16 at 3:14 p.m., an interview was conducted with the Chief Nursing Officer (CNO #5) who stated if an RN was assigned to 14 patients: the timeliness of medication administration could have been impacted. CNO #5 stated s/he was not aware of patient medications being given late per facility policy.

Based on interviews and document review, the facility failed to provide nursing staff to meet patients' needs and care. The facility failed to ensure nursing care was provided in accordance with acceptable standards of practice during medication administration.

This failure created delays in medications administration which could change or impact the intended therapeutic or pharmacological effect of the prescribed medication.

FINDINGS:

POLICY

According to the policy, Medication Management: Administration, non-time-critical medications will be administered within 1 hour before or after the scheduled dosing time, for a total window of 2 hours. These are medications for which a longer or shorter interval of time since the prior dose does not significantly change the medication's therapeutic effect.

Time-critical medications will be administered within 30 minutes before or after the scheduled dosing time, for a total window of 1 hour. These are medications for which an early or late administration of greater than thirty minutes may have significant impact on the therapeutic or pharmacological effect. Medications/medication classes that apply include: any medication prescribed more frequently than every 4 hours, anticonvulsant's (scheduled), immune agents (scheduled), pain medication (scheduled).

1. The facility failed to ensure patients received their scheduled medications within the appropriate time frame.

a) On 06/02/16 at 7:48 a.m., an interview was conducted with Registered Nurse (RN) #1 who stated the RN to patient ratio on the East unit of the Adult Behavioral Unit was high at nights. RN #1 stated the prior week, s/he was assigned to 14 patients, which resulted in patients receiving his/her medications after the scheduled time frame.

b) On 06/02/16 at 9:40 a.m., an interview was conducted with RN #2 who worked in the Adult Behavioral Unit during the day shift. RN #2 stated, although s/he worked the day shift, s/he noticed the night shift was frequently short staffed RNs, specifically the east unit.

c) Review of staffing for the night shift on 05/23/16, revealed RN #1 was assigned for the care of 13 patients on the East Unit. Two of the 13 patients' Medication Administration Records (MARs) were reviewed and showed scheduled medications were given outside of the time frame allowed per policy. Patient A was scheduled to be given 2 non-time-critical medications at bedtime, 09:00 p.m. Both medications were documented as given by another RN assigned to the West Unit, approximately 28 minutes past the 1 hour time frame allowed by policy. Patient B was scheduled 3 medications at 9:00 p.m. One of the medications was a time-critical medication, Lamictal, which was an antiseizure medication. RN #1 documented the medication was given 1 hour and 30 minutes after the scheduled time frame. This was in contrast to policy.

d) Review of staffing for the night shift on 05/26/16, revealed Registered Nurse (RN #3) was assigned for the care of 14 patients on the East Unit. Two of the 14 patients Medication Administration Records (MARs) dated 05/26/16 were reviewed and showed scheduled medications were given outside of the time frame allowed per policy. Patient A was scheduled to have been given a non-time-critical medication at bedtime, 9:00 p.m. RN #3 documented the medication was given at 10:28 p.m., which was 28 minutes after the 1 hour time frame allowed. Patient B was scheduled to have been given 2 non-time-critical medications and 1 time-critical medication at bedtime. All 3 medications were given outside of the time allowed according to policy. The time-critical medication, Depakote, which was given to prevent seizures, should have been given within 30 minutes prior to or after 9:00 p.m. RN # 3 documented the medication was given at 10:05 p.m.

e) Review of staffing for the night shift on 05/27/16, revealed RN #4 was assigned for the care of 11 patients on the East Unit. Two of the 11 patients' MARs were reviewed and showed Patient B was scheduled to be given 1 non-time-critical medication at 9:00 p.m.. RN #4 documented the medication was given at 10:19 p.m. This was in contrast to policy.

f) On 06/02/16 at 3:14 p.m., an interview was conducted with the Chief Nursing Officer (CNO #5) who stated if an RN was assigned to 14 patients: the timeliness of medication administration could have been impacted. CNO #5 stated s/he was not aware of patient medications being given late per facility policy.