HospitalInspections.org

Based on record reviews, interview, and review of the Critical Access Hospital's policies, the Critical Access Hospital (CAH) failed to ensure medications were administered with a physician order in the Emergency Department (ED) and wound care orders for Patient #7 were documented.

The findings include:

Patient 3
On 9/20/23 at 9:00 AM, review of Patient 3's record revealed the patient was admitted to the CAH's ED on 6/1/23 with a diagnosis of altered mental status and homicidal ideation. Patient 3 was transferred from the ED on 6/8/23. The Medication Administration Record (MAR) indicated the following medications were administered from 6/2/23 to 6/8/23:
Vraylar 6 mgs (milligrams) one at bedtime (daily)
Fluoxetime 40 mg two capsules every morning
Topiramate 100 mg tablet twice a day
Neurontin 300 mg one in the morning and two at bedtime
Cholecalciferol (Vitamin D) 25 mcg (micrograms) one in the morning
Naproxen 500 mg one tablet twice a day as needed
Furosemide 20 mg one tablet every other day
Invega 234 mg intramuscularly one time on 6/2/23
There were no physician orders in Patient 3's record for the administration of the medications.
On 9/20/23 at 12:30 PM, during an interview with the ED Clinical Lead (Registered Nurse 2), he/she reviewed Patient 3's record and confirmed the findings.

Patient 7
On 09/19/2023 at 1:55 PM, review Patient #7's chart revealed the patient was admitted to Acute Care status from Swing bed status on 03/09/2023. On 03/12/2023 at 11:00 AM, the nurse documented "patient in bed. patient verbally moaning during dressing change. resident wound is large and has a foul odor. dressing changed. MD (Medical Doctor) notified about labs and wound ...". On 03/13/2023 at 11:34 AM, the nurse documented "SACREL[sic] DEC (Decubitus) . MEASURED W (width)13 CM (centimeters) LEN(length),7 ½ CM". On 03/14/2023 at 8:00 AM, the nurse documented, "Wound on sacral examined by PT (Physical Therapist) and MD and Nurse Practitioner this AM. Allevyn dressing was changed after the wound was examined ...". On 03/17/2023 at 8:00 AM, the nurse documented "Dressing on sacrum changed with MD in the room to visualize the wound. Wound was cleaned with sterile water and 2 allevyn 5X5 dressings applied to the sacrum". On 03/18/2023 at 3:11 PM, the nurse documented "DRESSING CHANGED ON SACRAL AREA. CLEANED WITH N.S. (Normal Saline)." The hospital did not provide documentation for wound care physician orders. On 09/19/2023 at 2:15 PM, Registered Nurse (RN) #3 reported he/she could not find documentation of wound orders and verified the finding.

On 9/20/23, the CAH's policy, titled, "Administration of Medications and Who May Administer Meds", revealed, " ...All orders are carried out after being entered on patient's profile by provider (physician nurse practitioner or physician assistant) ...".

Based on interview and record review, the Critical Access Hospital (CAH) swing bed program failed to have a written policy and procedure for mistreatment, neglect, and abuse of residents and misappropriation of resident property.

The findings include:

Record review on 09/19/23 at 10:05 AM of the Swing Bed policies and procedures revealed no documentation for a written policy and procedure for mistreatment, neglect, and abuse of residents and misappropriation of resident property for swing bed residents. During an interview on 09/20/23 at 12:32 PM, Quality Risk Manager (QRM) stated, "The book I provided for Social Services is all that I have for swing bed patients for policy and procedures.