HospitalInspections.org

Based on observation and interview, the hospital failed to ensure patients had the right to personal privacy. This deficient practice is evidenced by the facility failing to provide window coverings for 5 of 20 patient rooms (Rooms a, b, c, d, e).
Findings:

Observation on 03/09/20 at 9:30 a.m. with S1DON revealed Rooms a, b, c, d and e had no window curtains or blinds, which allowed visual exposure into the room from outside the hospital.

On 03/10/20 at 1:45 p.m., interview with S4Maintenance revealed that the hospital had a shortage of curtains.

On 03/10/20 at 2:00 p.m., interview with S1DON confirmed that the above rooms without curtains failed to ensure the patients had privacy. S1DON further confirmed that the windows allowed visual exposure into the rooms from outside the facility.

Based on observation, record review and interview, the RN failed to ensure patients were observed by mental health technicians at the ordered level of observation for 1 of 1 patient (Patient #3) observed for observation levels of line of sight in a total sample of 30.
Findings:

Review of the hospital policy titled, "Close Observation / 1:1 Supervision", revealed in part that patients on Level II (close observation with continuous visual contact) will be within staff visual field at all times. The policy further stated that close observation procedures would be documented in the medical record to include level of observation and frequency of staff contact.

On 03/09/2020 at 10:00 a.m., observation revealed that S3BHT was walking down Patient #3's hall. The surveyor asked to review the documentation of the observations of Patient #3. Review of Patient #3's close observation record revealed that there was documentation every 15 minutes of the patient up until 9:00 a.m. that morning. Interview with S3BHT at that time confirmed that Patient #3 was a Level II/line of sight observation but that he was behind on his documentation. When asked who was observing Patient #3 at that time, he stated that the patient should be in a group meeting being observed by other staff.

On 03/09/2020 at 12:40 p.m. and 1:00 p.m., observation revealed Patient #3's door was shut to his room. Further observations revealed the patient was alone in his room. There was no staff observed on the hall at the above times.

On 03/10/2020 at 2:00 p.m., S1DON confirmed that Patient #3 had a physician order to have a line of sight observation level. S1DON further confirmed that the patient should not be in his room alone with the door closed.

Based on record review and interview, the hospital failed to administer medication as ordered by the physician and by acceptable standards of practice as evidenced by failing to administer sliding scale insulin per physician orders for 2 of 2 patients (Patient #8, #14) reviewed for sliding scale insulin in a total sample of 30.
Findings:

Patient #8
Review of the medical record for Patient #8 with S1DON revealed an order dated 03/06/2020 for dextrosticks three times daily with sliding scale Humalog insulin. Further review of the sliding scale revealed it included:
376-400, give 17 units of Humalog
Over 400, notify physician

Review of the medical record revealed that on 03/06/2020 at 4:00 p.m., the patient's dextrostick reading was 465 and 17 units of Humalog insulin was administered. Review of the sliding scale insulin order revealed that if dextrostick is over 400, to notify the physician. Further review of the record revealed no documented evidence that the physician was notified of this result.

Review of the record revealed that on 03/08/2020 at 2:00 p.m., the patient's dextrostick reading was 450. Review of the sliding scale insulin order revealed that if dextrostick is over 400, to notify the physician. Further review of the record revealed no documented evidence that the physician was notified of this result.

On 03/11/2020 at 10:00 a.m., S1DON reviewed the patient's medical record and confirmed that the sliding scale insulin was not administered as ordered and there was no documented evidence that the physician was notified of the above blood glucose results over 400.

Patient #14
Review of the physician orders dated 03/03/2020 revealed orders to check patient's blood glucose twice daily with Novolog sliding scale insulin. Review of the order for Novolog sliding scale insulin revealed it included the following:
351-375, give 11 units Novolog insulin
376-400, give 12 units Novolog insulin

Review of the record revealed that the patient's blood glucose on 03/04/2020 at 8:00 p.m. was 459 and 12 units of Novolog insulin was administered. There was no order to administer 12 units of Novolog for a result of 459 and there was no documented evidence that the physician was notified of this high result.

Review of the record revealed that the patient's blood glucose on 03/07/2020 at 8:00 p.m. was 414 and 12 units of Novolog insulin was administered. There was no order to administer 12 units of Novolog for a result of 414 and there was no documented evidence that the physician was notified of this high result.

Review of the record revealed that the patient's blood glucose on 03/08/2020 at 8:00 p.m. was 398 and 10 units of Novolog insulin was administered. Review of the ordered sliding scale revealed that 12 units should have been administered.

Review of the record revealed that the patient's blood glucose on 03/09/2020 at 8:00 p.m. was 454 and 11 units of Novolog insulin was administered. There was no order to administer 11 units of Novolog for a result of 454 and there was no documented evidence that the physician was notified of this high result.

On 03/11/2020 at 10:30 a.m., S1DON reviewed the patient's medical record and confirmed that the sliding scale insulin was not administered as ordered. S1DON further confirmed that there was no order to administer sliding scale insulin for results over 400 and the nurses should have contacted the physician for those high results.

Based on record review and interview, the hospital failed to ensure all medication orders (except in emergency situations) were reviewed by a pharmacist (for therapeutic appropriateness, duplication of a medication regimen, appropriateness of the drug and route, appropriateness of the dose and frequency, possible medication interactions, patient allergies and sensitivities, variations in criteria for use, and other contraindications) before the first dose was dispensed.

Findings:

Review of the Louisiana Administrative Code, Title 46 Professional and Occupational Standards, Part LIII Pharmacist, Chapter 15 Hospital Pharmacy, Section: 1511: Prescription Drug Orders, Item A. The pharmacist shall review the practitioner's medical order prior to dispensing the initial dose of medication, except in cases of emergency.

Review of the hospital's Dispensing Pharmacy Agreement with Pharmacy A, revealed that a pharmacist would conduct an evaluation of the first dose of any medication and screen the patient's current diagnoses and medication regimen for pertinent information.

Review of the Medication Override Report dated 12/01/19-03/08/2020 revealed 89 medication order overrides of the Omnicell medication system with various reasons documented (59 listed as "floor charge" and linked with patient names).

On 03/10/2020 at 2:40 p.m., review of the override report with S1DON revealed he was not sure what the reason identified as "floor charge" meant. He confirmed that the documented reasons for the majority of the overrides were not valid justifications for an override, and that the nurses should have contacted the pharmacy for profiling and first dose reviews rather than overriding the system. Further interview with S1DON revealed that S2Pharmacist, who supervises the pharmacy services, reviews the override reports. S1DON stated that S2Pharmacist had not consulted with him regarding the overrides of the Omnicell medication system.