HospitalInspections.org

Based on document review and interview, nursing services failed to administer medications at standardized times/frequencies in 3 of 10 patient medical records (MR) reviewed (P1, P5, and P10).

Findings include:

1. Review of policy/procedure "Medication Administration Times - System," indicates the following:
V. Policy Statements:
A. Standardized times/frequencies for the administration of medication will be coordinated in order to provide safe, practical and optimal therapeutic results.
F. Time-critical medications should be administered within 30 minutes before or 30 minutes after the scheduled dosing time, for a total window that does not exceed 1 hour.
1. Time-critical medications are typically those that are entered with interval frequencies six times a day or more frequent every 4 hours (Q4H), every 2 hours (Q2H)).
G. Non time-critical medications should be administered within 1 hour before or 1 hour after the scheduled dosing time for a total window that does not exceed 2 hours.
1. Non time-critical medications are those entered with interval frequencies less frequent than six times a day (e.g., every 6 hours (Q6H), every 8 hours (Q8H), every 12 hours (Q12H)) or those entered with timed frequencies (e.g., three times a day (TID), twice a day (BID).

2. Review of P1's MR indicated the following:
On 07/14/24 at 2152 hours P1 had an order to receive acetaminophen 1000 mg orally every 8 hours (Q8H); on 07/14/24 P1 received a dose of acetaminophen at 2352 hours with their next dose due at 07/15/24 at 0752 hours; MR indicated on 07/15/25 P1 was given a dose of acetaminophen at 0535 hours with the next dose due at 1335 hours; MR indicated on 07/15/25 P1 was given acetaminophen at 1951 hours.

3. Review of P5's MR indicated the following:
On 06/12/24 P5 had an order to receive tamsulosin 0.4 mg orally daily and famotidine 20 mg orally (BID).
On 06/12/24 P5 received a dose of famotidine at 0959 hours with their next dose due at 2100 hours; MR indicated on 06/12/24 P5 was given a dose of famotidine at 2215 hours.
On 06/13/24 P5 had an order to receive acetaminophen 1000 mg orally three times a day (TID) and dronedarone 400 mg orally BID. On 06/15/24 P5 received a dose of acetaminophen at 2122 hours with next dose due on 06/16/24 at 0900 hours. MR indicated on 06/16/24 P5 was given a dose of acetaminophen at 1003 hours.
On 06/15/24 P5 received a dose of dronedarone at 2122 hours with next dose due on 06/16/24 at 0900 hours. MR indicated on 06/16/24 P5 was given a dose of dronedarone at 1003 hours.
On 06/14/24 P5 had an order to receive apixaban 2.5 mg orally BID, polyethylene glycol 3350 17 GM orally BID, senna (senna (sennosides) - 8.6 mg oral tablet) 2 tablets orally BID, and levothyroxine 150 micrograms (mcg) orally daily.
On 06/15/24 P5 received a dose of apixaban at 2122 hours with next dose due on 06/16/24 at 0900 hours. MR indicated on 06/16/24 P5 was given a dose of apixaban at 1003 hours.
On 06/15/24 P5 received a dose of famotidine at 2122 hours with their next dose due 06/16/24 at 0900 hours. MR indicated on 06/16/24 P5 was given a dose of famotidine at 1003 hours.
On 06/15/24 P5 received levothyroxine at 0616 hours with their next dose due on 06/16/24 at 0600 hours. MR indicated on 06/16/24 P5 was given a dose of levothyroxine at 0452 hours with their next dose due 06/17/24 at 0600 hours. MR indicated on 06/17/24 P5 was given a dose of levothyroxine at 0303 hours.
On 06/15/24 P5 received a dose of polyethylene glycol 3350 at 2122 hours with their next dose due 06/16/24 at 0900 hours. MR indicated on 06/16/24 P5 was given a dose of polyethylene glycol 3350 at 1003 hours.
On 06/15/24 P5 received a dose of senna at 2122 hours with their next dose due 06/16/24 at 0900 hours. On 06/16/24 P5 received a dose of senna at 1003 hours.
On 06/15/24 P5 received a dose of tamsulosin at 2122 hours with their next dose due 06/16/24 at 0900 hours. MR indicated on 06/16/24 P5 was given a dose of tamsulosin at 1003 hours.
On 06/17/24 P5 received a dose of acetaminophen at 0922 hours with the next dose due at 1500 hours. MR indicated on 06/17/24 P5 was given a dose of acetaminophen at 1648 hours.

4. P10's Medication Administration Record (MAR) indicated the following:
On 08/21/24 P10 had an order to receive docusate-senna (docusate-senna 50 milligrams (mg) - 8.6 mg oral tablet) 2 tablets orally twice a day (BID), enoxaparin 40 mg subcutaneous injection BID, losartan 50 mg orally daily, and methocarbamol 1500 mg orally every 6 hours (Q6H).
On 08/21/24 P10 received a dose of docusate-senna at 2214 hours with next dose due on 08/22/24 at 0900 hours; MR indicated on 08/22/24 P10 was given a dose of docusate-senna at 1435 hours.
On 08/21/24 P10 received a dose of enoxaparin at 2214 hours with next dose due 08/22/24 at 0900 hours; MR indicated on 08/22/24 P10 received a dose of enoxaparin at 1435 hours.
On 08/22/24 P10 had an order to receive tamsulosin 0.8 mg orally daily; MR indicated losartan was given at 1435 hours; MR indicated it should have been given at 0900 hours.
On 08/22/24 P10 received a dose of methocarbamol at 0113 hours with next dose due at 0713 hours; MR indicated methocarbamol was given at 1322 hours.
On 08/22/24 MR indicated tamsulosin was given at 1435 hours; MR indicated it should have been given at 0900 hours.
On 08/23/24 P10 received a dose of methocarbamol at 1719 hours with next dose due at 2319 hours; MR indicated on 08/24/24 P10 received a dose of methocarbamol at 0025 hours.

5. Interview with A2 (Master of Science in Nursing [MSN], RN) on 10/16/24 at approximately 10:00 a.m., confirmed P1, P5, and P10 did not receive prescribed medications at prescribed times.

6. Interview with A6 (Unit Manager) on 10/16/24 at approximately 3:15 p.m., indicated they have an hour before or after the administration time to give a scheduled medication.

7. Interview with A7 (Registered Nurse [RN] Charge Nurse) on 10/16/24 at approximately 3:20 p.m., indicated they have 30 minutes to 1 hour before or after the administration time to give a scheduled medication.