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Based upon observations and staff interview, the hospital failed to ensure the patients in the psychiatric unit were provided care in a safe setting. This was evidenced by the hospitals failure to ensure: 1) the beds did not hand rails, 2) the plumbing behind the toilets was enclosed, and 3) the hand held shower head in room #1 had a long hose connected to the wall. Findings:

Observations on the Psychiatric Unit on 2/26/14 at 9:45 a.m. revealed the unit had ten rooms/ten beds. All of the beds had 4 side rails (two upper and two lower). The following was also observed:

1) All toilets in the patient bathrooms had exposed plumbing extending up to the flush lever;

2) The sinks in all of the patient rooms had goose neck faucets and along with hot and cold flange levers;

3 Rooms #1 and #7 had oxygen flow meters attached to the oxygen wall outlets;

4) Room #1 had a detachable shower head with a long cord which was connected to the wall.

During the environmental tour observations, S8 RN, Psychiatric Unit Director, confirmed the identified concerns.

Based on interview and policy review, the hospital failed to ensure patient safety through the appropriate control and distribution of drugs by failing to determine appropriateness of the prescriber ' s medication orders for each patient. The hospital failed to perform 1st dose medication review for the following: therapeutic appropriateness of a patient ' s medication regimen; therapeutic duplication in the patient ' s medication regimen; appropriateness of the route /method of administration; medication-medication, medication-food, medication-laboratory test & medication - disease interactions; clinical and lab data to evaluate the efficacy of medication therapy to anticipate or evaluate toxicity & adverse effects; and physical signs and symptoms relevant to the patient ' s medication therapy on medications ordered; prior to medication administration in non- emergent circumstances.

Findings:
Review of the policy entitled Medication Use-After Hours Review, Issued: 2/28/12, Revised: 8/21/13, Reviewed: Annually, revealed the following, in part:
Purpose:
To provide guidelines for the review of medication orders written after the pharmacy is closed.
Policy:
Prior to the administration of a medication to a patient, State law requires that non-emergency medication orders be reviewed and approved by a pharmacist. When necessary, the pharmacist will access the system and review any such orders. The following procedure will be followed:
When a new order is placed for a patient, the pharmacist on call will return to work to review the order. If the order is complete and correct, the pharmacist will verify it as such.
Once verified by the pharmacist, the nurse may administer the medication as ordered utilizing floor stock, Serve RX, or the night cabinet supply.
These procedures will be followed for all non-emergency orders received when the pharmacy is not open prior to administration of any medication.
Orders which will be considered Emergency Orders are:
Orders for medications for patients of the Emergency Room at the facility; STAT (immediate) orders, NOW orders, One Time or x 1 orders for antibiotic therapy, Any other orders deemed as emergency by the ordering physician.
Orders placed for medications which fit any of the descriptions above are exempt from the requirement of pharmacy review prior to the initial administration.

In an interview on 2/26/14 at 4:00 p.m., S4 Pharmacy Director stated the first dose review was not performed on medications deemed, per hospital policy, as Emergency Orders, including medications ordered on the inpatient units. She said the following orders were considered emergency medication orders: Orders for medications for patients in the emergency room, STAT orders, Now orders, One time or x (times) 1 orders, Initial orders, STAT, or x1 orders for antibiotic therapy, and any other orders deemed as an emergency by the ordering physician. She said the hospital did not have a remote pharmacist available to perform 1st dose review after hours and she could not, per the Louisiana State Board of Pharmacy, view orders from home. She agreed not all of the orders the hospital classified as " emergency " orders, which were considered exempt from 1st dose review per hospital policy, were truly emergency orders. She also agreed medications ordered on the floor, when the patient was not in distress, were not emergency orders.