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Based on review of facility policy, medical records (MR) and interview with staff (EMP), it was determined the facility failed to ensure that medications were administered according to signed orders of a practitioner for three of three medical records reviewed.(MR1, MR2, and MR3).

Findings include:

A review on June 8, 2012 of facility policy "Subject: Medication Administration and Documentation," dated February 2011 revealed "...Procedure:...2. Medications are administered by licensed RNs/LPNs according to state and Federal regulations and professional standards ..."

1) A review on June 8, 2012, of MR1 revealed a physician's medication order which indicated "Humulin R Insulin...Dose: 1 Units...Rte: Sub-Q...Freq: PRN...BS: 0 - 200 = 0 UN/ - 201 - 250 = 4 UN/ 251 - 300 = 6 UN 301 - 350 = 8 UN/ 351 - 400 = 10 UN/ > 400 = Call MD..."

A review on June 8, 2012, of MR1 revealed the following:

On April 18, 2012, at 9:25 PM the patient's blood sugar was 352 mg/dL. There was no documentation that the patient received 10 units of Humulin Regular Insulin per the sliding scale physician order.

On April 19, 2012, at 9:50 PM, the patient's blood sugar was 248 mg/dL There was no documentation that the patient received 4 units of Humulin Regular Insulin per the sliding scale physician order.

On April 24, 2012, at 9:28 PM the patient's blood sugar was 240 mg/dL. There was no documentation that the patient received 4 units of Humulin Regular Insulin per the sliding scale physician order.

An interview conducted on June 8, 2012, at approximately 11:00 AM with EMP1 confirmed that MR1 did not contain documentation that the patient received insulin as ordered by the physician.

2) A review on June 8, 2012, of MR2 revealed a physician's medication order which indicated "Humulin R Insulin...Dose: 1 Units...Rte: Sub-Q...Freq: PRN...BS: 0 - 200 = 0 UN/ - 201 - 250 = 4 UN/ 251 - 300 = 6 UN 301 - 350 = 8 UN/ 351 - 400 = 10 UN/ > 400 = Call MD..."

A review on June 8, 2012, of MR2 revealed the following:

On May 25, 2012, at 4:32 PM the patient's blood sugar was 238 mg/dL. There was no documentation that the patient received 4 units of Humulin Regular Insulin per the sliding scale physician order.

An interview conducted on June 8, 2012, at approximately 11:00 AM with EMP1 confirmed that MR2 did not contain documentation that the patient received insulin as ordered by the physician.

3) A review on June 8, 2012 ,of MR3 revealed a physician's medication order which revealed "Humulin R Insulin...PRN...Sub-Q...BS: 0 - 200 = 0 UN/ - 201 - 250 = 4 UN/ 251 - 300 = 6 UN 301 - 350 = 8 UN/ 351 - 400 = 10 UN/ > 400 = Call MD..."

A review on June 8, 2012, of MR3 revealed the following:

On October 6, 2011, at 4:06 PM the patient's blood sugar was 347 mg/dL There was no documentation that the patient received 8 units of Humulin Regular Insulin as ordered by the physician.

On October 6, 2011, at 10:02 PM the patient's blood sugar was 347 mg/dL. There was no documentation that the patient received 8 units of Humulin Regular Insulin as ordered by the physician.

On October 7, 2011, at 5:40 AM the patient's blood sugar was 215 mg/dL There was no documentation that the patient received 4 units of Humulin Regular Insulin as ordered by the physician.

On October 7, 2011, at 3:24 PM the patient's blood sugar was 294 mg/dL There was no documentation that the patient received 6 units of Humulin Regular Insulin as ordered by the physician.

On October 7, 2011, at 10:00 PM the patient's blood sugar was 206 mg/dL There was no documentation that the patient received 4 units of Humulin Regular Insulin as ordered by the physician.

On October 9, 2011, at 1:52 PM the patient's blood sugar was 258 mg/dL There was no documentation that the patient received 4 units of Humulin Regular Insulin as ordered by the physician.

On October 10, 2011, at 11:36 AM the patient's blood sugar was 267 mg/dL There was no documentation that the patient received 4 units of Humulin Regular Insulin as ordered by the physician.

On October 11, 2011, at 11:21 AM the patient's blood sugar was 249 mg/dL There was no documentation that the patient received 4 units of Humulin Regular Insulin as ordered by the physician.

An interview conducted on June 8, 2012, at approximately 11:00 AM with EMP1 confirmed that MR3 did not documentation that the patient received insulin as ordered by the physician.

Based on review of facility policy, observation and interview with staff (EMP), it was determined that the facility failed to ensure that supplies were maintained to ensure an acceptable level of safety.

Findings include:

A review on June 7, 2012, of facility policy, "Subject: Sterile Supplies," last revised July 2008 revealed "...Procedure: 1. Sterile supplies are ordered and stocked according to Materials Management policies. Any item which is outdated, improperly wrapped, or appears to have been tampered with is removed and returned to the Materials Management Department for return to vendor or disposal..."

1) Observation on June 7, 2012, of the medication supply room in the Adult D'Arclay Psychiatric Unit revealed four 3M Steri Strip packet's marked expired August 2000.
An interview conducted on June 7, 2012, at 9:40 AM with EMP1 confirmed the above mentioned products were expired.

2) Observation on June 7, 2012, of the medication supply room in the Adult D'Arclay Two West Nursing Unit revealed the following expired products: one Hydrogen Peroxide 16 ounce bottle marked expired February 2011; nine 3M Steri Strip packet's marked expired August 2008; two 3M Steri Strip packet's marked expired April 2011; and four Kendall Vaseline packet's marked expired April 2011.
An interview conducted on June 7, 2012, at 10:15 AM with EMP1 confirmed the above mentioned products were expired.

3) Observation on June 7, 2012, of the facility's Lab Room revealed the following expired products: five boxes each containing 100 packet's of Povidone Iodine Prep Pads marked expired June 2010; 48 BD Vacutainer urine C&S transport kit's for midstream specimens marked expired December 2002; one box of Coagu Chek Xs Plus Patient controls marked expired September 2010; 10 BD Vacutainer's marked expired April 2009; four BD Vacutainer's marked expired December 2010; one Copan Venturi Transystem Transport swap packet marked expired October 2011; one bottle marked 100 gram Cobalt Chloride marked opened March 14, 1984; and one alcohol wall mounted hand sanitizer marked expired October 2010.
An interview conducted on June 7, 2012, at 10:45 AM with EMP1 confirmed the above mentioned products were expired.