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Based on observation and interview, the facility failed to ensure all medications in the Emergency Room (ER) were secured. Failure to secure medications may result in patients accessing and overdosing on the medications.

Findings:

Observation of the ER on 07/28/10 at 10:15 AM, with the Registered Nurse (RN) on duty revealed three beds separated by curtains. Further observation of the ER revealed a patient in the bed located at the far left of the room and another patient in the middle bed. The curtain around the far left bed was drawn on all sides, leaving a small opening in the front of the patient, facing the ER entrance.

Observation of the ER medications on 06/28/10 at 10:25 AM with the RN on duty revealed the refrigerator located behind the patient to the far left of the room was unlocked. Observation of the medications contained within the refrigerator revealed Lorazepam 2 milligrams (mg), Azithromycin, Tetanus Toxoid, insulin, and diltrozen HCI injections as some of the medications.

Interview with the RN on 06/28/10 at 10:25 AM confirmed that the refrigerator was unlocked with the lock lying on top of the refrigerator.

Based on observation and interview, the facility failed to ensure that all Scheduled II, III, IV and V medications were kept locked and secured. Failure to secure these medications may result in patients' gaining access and overdosing on the medications.
Findings:

Observation of the ER on 06/28/10 at 10:15 AM, with the Registered Nurse (RN) on duty revealed three beds separated by curtains. Further observation of the ER revealed a patient in the bed located at the far left of the room and another patient in the middle bed. The curtain around the far left bed was drawn on all sides, leaving a small opening in the front of the patient, facing the ER entrance.

Observation of the ER medications on 06/28/10 at 10:25 AM with the RN on duty revealed the refrigerator located behind the patient to the far left of the room was unlocked. Observation of the medications contained within the refrigerator revealed Lorazepam 2 milligrams (mg).

Interview with the RN on 06/28/10 at 10:25 AM confirmed that the refrigerator was unlocked with the lock lying on top of the refrigerator.

Based on observation, facility record review and interview the facility failed to maintain instruments and equipment to ensure an acceptable level of safety and quality. The facility failure to ensure that instruments and equipment were properly maintained may lead to patient wound infections and hazardous conditions for staff and patients.

Findings:

During the tour of the operating room, recovery room and clean/dirty instrument rooms on 6/28/10 at 1:30 PM it was noted that the operating room lights were due to be inspected on May, 2008.

Interview of the Director of Support Services, who was present during the tour, on 6/28/10 at 1:30 PM it was revealed that the operating room lights were inspected recently and he would provide the information.

On 6/30/10 at 2:45 PM another tour was conducted of the clean instrument processing area along with the maintenance director and the Director of Support Services. A counter draped in blue paper contained many individual packages of instruments. On the blue wrap a note was written that "2 cycles at 30 minutes each with 10 minute dry time, 282 pieces total, result satisfactory, no units discarded."

Interview with the maintenance director on 6/30/10 at 3:30 PM stated that when the outside vendor serviced the Autoclave he was in-serviced on the use of the machine. He stated that he in-serviced the instrument technician hired by the facility.

Based on observation and interview, the facility failed to ensure they provided 1 of 29 (#11) patients with prescriptions as prescribed by the physician. Failure to ensure all patients receive their medications as prescribed may result in further decline in the patients' medical condition.
Findings:Review of patient #11's record revealed the patient was admitted in to the facility on 06/13/10. Further review of this record revealed a Medication Administration Record (MAR). Review of the MAR revealed the patient was prescribed on 06/13/10 synthroid 25 microgram (mcg) to be provided every morning, on 06/14/10 the patient was prescribed aspirin 81 milligrams (mg), to be taken every morning, Norvasc 5 mg to be taken every morning, lopressor 12.50 mg to be provided twice a day. According to the MAR, on 06/15/10, the physician prescribed Lactulose 30 cubic centimeter (cc) twice a day and on 06/16/10 the physician prescribed 50 mcg of synthroid to be given every morning. Further review of this MAR failed to reveal a signature for the 25 mcg dosage of synthroid on 06/17/10 and 06/18/ 10. The MAR also failed to reveal a signature, indicating all of the medications were given on 06/18/10. According to patient #11's record, the patient was transferred to another hospital on 06/20/10. Further record review failed to reveal physician's orders discontinuing all of the above listed medications prior to the patient being transferred.

Interview with the Director of Nursing (DON) on 06/30/10 at 9:19 AM revealed that she was unable to locate any physician's orders discontinuing the synthroid 25 mcg on 06/17/10 or any of the other medications prior to the 06/18/10 administration. Further interview with the DON revealed she was not sure why the patient did not receive his/her medications.