HospitalInspections.org

1. Based on staff interview, and clinical record review, it was determined the facility failed to assure nursing care plans were initiated on admission, reviewed and revised to
reflect patient needs for 4 (Patient #2, 6,18, 20) of 21 active clinical records (Patient #2, 3, 5, 6, 10-12, 16, 18 -30). The failed practice had the potential to affect 87 patients hospitalized on the third and fourth floor. Findings follow:

A. Review of Clinical Record #2 on 08/20/10 at 0950 revealed an admission date of 08/17/10 at 1152. The Nursing Care Plan was noted to include the problem "At risk for hypo/hyperglycemic/electrolyte imbalance R/T (related to) Diarrhea," which was signed and dated 08/19/10. LPN (Licensed Practical Nurse) #1 confirmed the findings by interview on 08/20/10 at 1000.
B. Review of Clinical Record #6 on 08/20/10 at 0950 revealed an admission date of 08/16/10 at 1941. The Nursing Care Plan was noted to include the problem " Alt. (alteration) respiratory status R/T (arrow down)decreased sats (saturation)," which was signed and dated 08/19/10. In an interview with the Medical Surgical Services Director on 08/20 at 1005, she verified the Nursing Care Plan was not initiated for Clinical Record #6 until 08/19/10.
C. Review of Clinical Record #18 on 08/20/10 at 1315 revealed an admission date of 08/10/10 at 1359. The Nursing Care Plan was noted to include the problem "Impairment of skin integrity R/T (blank), and Actual/potential alt. in tissue perfusion R/T Diabetic wound, which was signed and dated 08/10/10. There was no evidence the Nursing Care Plan was reviewed or revised from 08/11/10-08/19/10. Interview with RN (Registered Nurse) #1 on 08/20/10 at 1330, she confirmed the findings for Clinical Record #18.
D. Review of Clinical Record #20 on 08/20/10 revealed an admission date of 08/07/10. The Nursing Care Plan was noted to include the problem "Anxiety R/T diagnosis." The first signature and date on the Nursing Care Plan was 08/16/10. The findings were confirmed by interview with RN #4 on 08/20/10.

2. Based on observation and interview, the facility failed to assure outdated medications and undated, opened multidose vials of medication were not available on anesthesia carts for patient use in three of three (#9-11) Outpatient Operating Rooms. The failed practice had the potential to affect all patients who had surgical procedures in Operating Rooms #9 -11 on 08/19/10. Findings follow:

A. Observation of Operating Room #9 on 08/19/10 at 1450 revealed the following out of date medications:
1) Succinylcholine, 200 mg/ml (milligrams/milliliter), one of three expired on 08/12/10;
2) Anidate 20 mg, 10 ml vial, one of four expired on 06/01/10;
3) Lidocaine HCL (hydrochloride) 2% injection 20 mg/ml, two of three expired 06/10 and 05/10; and
4) Doxepram 400 mg/20 ml, Neostigmine Methylsulfate 1 mg/ml, 10 ml, and one of four Zenuron 10 mg/ml, were opened and not dated, therefore it could not be determined if the vials were in use past 28 days. The APIC (Association for Professionals in Infection Control and Epidemiology, Inc.) Position Paper, "Safe Injection, Infusion and Medication Vial Practices in Healthcare", 07/30/09, stated "Dispose of opened multidose medication vials 28 days after opening, unless specified otherwise by the manufacturer, or sooner if sterility is questioned or compromised." Source of Reference United States Pharmacopeia (USP) 797: Guidebook to Pharmaceutical Compounding-Sterile Preparations, Second Edition, 06/01/08.
B. Observation of Operating Room #10 on 08/19/10 at 1504 revealed the following outdated medications:
1)Hydralazine Hydrochloride 20 mg/ml, five of five single dose vials expired 07/10;
2) Lidocaine HCL 20 mg/ml, one of two expired 05/10;
3) Lidocaine 2%, 20 mg/ml (20 ml) vial; and
4) Zemuron 10 mg/ml, one of three were opened and not dated, therefore it could not be determined if the vials were in use past 28 days.
C. Observation of Operating Room #11 on 08/19/10 at 1515 revealed Succinylcholine, 200 mg/ml expired 03/2010 and 11/09.
D. The findings were confirmed by interview with CRNA (Certified Registered Nurse Anesthetist) #1 on 08/19/10 at 1520.