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Based on documentation review and interview, the hospital failed to have the physician and nurse practitioner review and sign verbal/telephone orders for 1 of 10 patients (Patient #1) whose 9 verbal/telephone orders were not reviewed and signed within 48 hours per hospital policy and in accordance with State law. Findings include:

Review of the medical record for Patient #1 revealed the following:

On 10/22/2011 a nurse practitioner gave a telephone order to the hospital staff and ordered Gabapentin 600-1200 mg oral 2-4 capsules three times a day as needed. She did not sign the telephone order until 10/31/2011 which is greater than 48 hours after the initial order.

On 10/22/2011, a nurse practitioner gave a telephone order to the hospital staff regarding Patient #1 for Hydromorphone 20 mg in NaCl 0.9%, Patient Controlled Analgesia (total volume= 20 ml) intravenous 20 ml. She did not sign the order until 10/31/2011, greater than 48 hours after she gave the order.

On 10/22/2011, a physician gave a telephone order to the hospital staff regarding Patient #1 for an inpatient consult to internal medicine. He did not sign the order until 11/3/2011, greater than 48 hours after he gave the order.

On 10/23/2011, a nurse pratitioner gave a telephone order to the hospital staff regarding Patient #1 for Hydromorphone 0.5-1 mg intravenous every 4 hours as needed for breakthrough pain. She did not sign the order until 10/31/2011, greater than 48 hours after she gave the order.

On 10/24/2011, a physician gave a verbal order to the hospital staff regarding Patient #1 for two intraprocedural medications, Bupivacaine-Epinephrine (PF) 0.5%-1:200,000 1-30 ml for one dose and thrombin solution 5,000 units topical for one dose. He did not sign the order for the two medications until 11/3/2011, greater than 48 hours after he gave the order.

On 10/24/2011, a physician gave a verbal order to the hospital staff regarding Patient #1 for bacitracin topical ointment one dose intraprocedural but did not sign the order until 11/3/2011, greater than 48 hours after he gave the order.

On 10/26/2011, a physician gave a verbal order to the hospital staff regarding Patient #1 for a physical therapy diagnosis. He did not sign the order until 11/3/2011, greater than 48 hours after he gave the order.

On 10/28/2011, a physician assistant gave a verbal order to the hospital staff regarding Patient #1 for an inpatient consult to urology. She did not sign the order until 10/31/2011, greater than 48 hours after the order was given.

On 10/28/2011, a physician gave an order to the hospital staff regarding Patient #1 for an OT treatment diagnosis. The order was not signed by him until 11/3/2011, greater than 48 hours after the order was given to the hospital staff.

Review of the hospital policy and procedure for Medical Staff Rules and Regulations
notes "Verbal/telephone orders must be electronically signed within 48 hours after the order is entered into Excellian." This was verified by Employee C/administration on January 13, 2012, at 4:30 p.m. She acknowledged providers did not sign verbal/telephone orders for Patient #1 within 48 hours according to the hospital policy.