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Based on record review and interview the facility failed to follow physician's orders for 1 (#1) of five sampled patients for daily weights, rounds and diagnostic testing.

The finding include:

Record review for patient #1 revealed an admission weight of 98 pounds or 44.7 kg. The attending physician wrote an order for daily weights on the order sheet on 12/10/11. Review of the flow sheets for nursing, reveals that there is no weight documented on 12/13/11, 12/14/11, 12/15/11, 12/28/11 and 12/30/11. The weights that are documented are all 75.3 kg, (162 pounds) except for 68.6 kg on 12/18/11. The Registered Dietician had noted and documented on 12/20/11 that she felt that the weight variances do not appear to what the actual weight of the patient is. Meal intake is sporadic with the documentation of Ensure Plus not always drunk by the patient. There is documentation of refusal of meals and drink and intake of food listed as low as "0".

Interview with the CNO on 2/23/12 at 2:00 PM, revealed that all of the electric beds have scales on them that the staff may weigh the patient daily.

Further review of the record for patient #1 revealed that the attending physician ordered a MRI of the Cervical Spine at Shands on 12/11/11. He ordered it to be done on 12/12/11 (per discharge summary).
On 12/12/11 there is a clarification order for MRI of Cervical Spine to evaluate C6 and C7, and C4 and C5 per Dr at Shands. The neck MRI was scheduled and done on 12/16/11. There is a progress note by the physician dated 12/17/11, that report is not available, 12/18/11 note states report still pending, on 12/19/11 reads still waiting for report, on 12/20/11 reads still has not been provided.
Review of the MRI report shows that the order was received at Shands on 12/15/11 at 1:12 PM and the test was done on 12/16/11. The complainant stated during the interview with them on 2/22/12 at 8:30 AM, that they went to Shands and got the copy of the MRI for the facility to read.

Intake and Output was ordered by the physician to be done on a daily basis. There is inconsistent documentation that intake and output in recorded or even offered. Documentation is missing on the following days: 12/16/11, 1/2/12 and 1/3/12. Documentation for meals consumed is also not always documented according to facility policy. (12/16/11, 12/18/11, 12/19/11, 12/21/11, 12/27/11, and 12/30/11.

Review of the facility policy reveals that meal and fluid is documented daily each shift, as well percentage taken.

Review of the facility policy for following physician's orders, reveal that the nursing staff will carry out their directives until discontinued by the physician.

Interview with the CNO on 2/23/12 at 2 PM, revealed that the flow sheets are the facilities assessments and are to be documented on each shift.

Based on record review and interview, the Registered Nurse (RN) failed to sipervise the nursing care provided to 1 of 5 (#1) patients regarding daily weights, rounds and diagnostic testing.

Findings,

1. Record review for patient #1 revealed an admission weight of 98 pounds or 44.7 kg. The attending physician wrote an order for daily weights on the order sheet on 12/10/11. Review of the flow sheets for nursing, reveals that there is no weight documented on 12/13/11, 12/14/11, 12/15/11, 12/28/11 and 12/30/11. The weights that are documented are all 75.3 kg, (162 pounds) except for 68.6 kg on 12/18/11. The Registered Dietician had noted and documented on 12/20/11 that she felt that the weight variances do not appear to what the actual weight of the patient is. Meal intake is sporadic with the documentation of Ensure Plus not always being consumed by the patient. There is documentation of refusal of meals and drink and intake of food listed as low as "0".

Interview with the Chief Nursing Officer (CNO) on 2/23/12 at 2:00 PM, revealed that all of the electric beds have scales on them that the staff may weigh the patient daily.

2. Further review of the record for patient #1 revealed that the attending physician ordered a magnetic resonance imaging (MRI) of the Cervical Spine at a named hospital on 12/11/11. He ordered it to be done on 12/12/11 (per discharge summary).
On 12/12/11 there is a clarification order for MRI of Cervical Spine to evaluate C6 and C7, and C4 and C5 per the physician at the named hospital. The neck MRI was scheduled and done on 12/16/11. There is a progress note by the physician dated 12/17/11, that report is not available, 12/18/11 note states report still pending, on 12/19/11 reads still waiting for report, on 12/20/11 reads still has not been provided.
Review of the MRI report shows that the order was received at the named hospital on 12/15/11 at 1:12 PM and the test was done on 12/16/11.

During interview with patient #1's relative on 2/22/12 at 8:30 AM, that they went to the named hospital and got the copy of the MRI for the facility to read.

3. Intake and Output was ordered by the physician to be done on a daily basis. There is inconsistent documentation that intake and output in recorded or even offered. Documentation is missing on the following dates: 12/16/11, 1/2/12 and 1/3/12. Documentation for meals consumed is also not always documented according to facility policy. (12/16/11, 12/18/11, 12/19/11, 12/21/11, 12/27/11, and 12/30/11).

Interview with the CNO on 2/23/12 at 2 PM, revealed that the flow sheets are the facilities assessments and are to be documented on each shift.

Review of the facility policy reveals that meal and fluid is documented daily each shift, as well percentage taken.

Review of the facility policy for following physician's orders, reveal that the nursing staff will carry out their directives until discontinued by the physician.