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Based on review of facility documents, medical records (MR), and staff interview (EMP), it was determined the facility failed to ensure nursing reassessments were conducted following the administration of pain medications for six of 14 applicable medical records reviewed (MR3, MR4, MR6, MR13, MR29 and MR31).

Findings include:

Review on March 20, 2012, of the facility's "Guidelines For: Pain Assessment Flow Sheet" policy, last revised November 2010, revealed "Policy: A Pain Assessment Flow Sheet will be initiated by an RN, GN, or LPN on all patients who experience acute or chronic, on-going or recurrent pain. Procedure: 1. Patients will be assessed for presence or absence of pain each shift or more frequently as the patient condition warrants, the RN/GN as appropriate. ... Reassessment: Reassess the patient within 60 minutes or more frequently as appropriate for effectiveness of analgesia/treatment for pain. Document the pain score as indicated by the patient's rating of his/her pain on the bottom of the flow chart in the designated area for reassessment. Nurse's Notes: Document any other information regarding the patient's assessment of his/her pain experience, [sic] or any of the nursing assessments relating to pain not already addressed. ..."

Review on March 20, 2012, of the facility's "Pain Management: Principles of Care" policy, last reviewed October 2011, revealed "Policy: Schuylkill Medical Center South Jackson Street believes that patients have the right to a maximal pain relief at all stages of their acute and/or chronic disease process. We recognize that appropriate pain management is critical in the care of patients and believe that all patients are entitled to a dignified, comprehensive and collaborative approach to pain management. ..."

1) Review on March 20, 2012, of MR3 revealed this patient's physician ordered Vicodin (a narcotic pain medication) 5/325 mg one tablet PO (orally) every four hours as needed for pain.

Review on March 20, 2012, of MR3's medication administration record (MAR) revealed nursing staff administered Vicodin 5/325 mg one tablet PO on March 19, 2012, at 8:40 PM and on March 20, 2012, at 9:40 AM. Further review of MR3 revealed no documentation that nursing staff reassessed this patient's pain level following the administration of Vicodin 5/325 mg one tablet PO on March 19, 2012, at 8:40 PM and on March 20, 2012, at 9:40 AM.

2) Review on March 20, 2012, of MR4 revealed this patient's physician ordered Morphine Sulfate (a narcotic pain medication) 5 milligrams (mg) intravenously (IV) every three hours as needed for severe pain and Percocet (a narcotic pain medication) 5/325 mg one tablet PO (orally) every four hours as needed for pain.

Review on March 20, 2012, of MR4's MAR revealed nursing staff administered Morphine Sulfate 5 mg IV on March 19, 2012, at 8:59 PM and on March 20, 2012, at 7:17 AM. Additional review of MR4's MAR revealed nursing staff administered Percocet 5/325 mg PO on March 20, 2012, at 1:35 AM and 5:29 AM. Further review of MR4 revealed no documentation that nursing staff reassessed this patient's pain level following the administration of the Morphine Sulfate 5 mg IV on March 19, 2012, and March 20, 2012, or following the Percocet 5/325 mg PO administered on March 20, 2012, at 1:35 AM and 5:29 AM.

3) Review on March 20, 2012, of MR6 revealed this patient's physician ordered Percocet 5/325 mg one tablet PO every four hours as needed for pain.

Review on March 20, 2012, of MR6's MAR revealed nursing staff administered Percocet 5/325 mg PO on March 19, 2012, at 5:38 PM. Further review of MR6 revealed no documentation that nursing staff reassessed this patient's pain level following the administration of the Percocet 5/325 mg PO administered on March 19, 2012, at 5:38 PM.

4) Review on March 20, 2012, of MR13 revealed this patient's physician ordered Vicodin 5/325 mg one tablet PO every 6 hours for pain.

Review on March 20, 2012, of MR13's MAR revealed nursing staff administered Vicodin 5/325 mg one tablet PO on March 19, 2012, at 6:58 AM. Further review of MR13 revealed no documentation that nursing staff reassessed this patient's pain level following the administration of the Vicodin 5/325 mg one tablet PO administered on March 19, 2012, at 6:58 AM.

5) Review on March 20, 2012, of MR29 revealed this patient's physician ordered Morphine sulfate 5 mg / 1 millimeter (ml) 5 mg intravenously (IV) every three hours for severe pain and Percocet 5/325 mg one tablet PO every four hours as needed for pain.

Review on March 20, 2012, of MR29's MAR revealed nursing staff administered Morphine Sulfate 5 mg IV on March 17, 2012, at 9:05 PM, on March 18, 2012, at 2:18 AM, and on March 19, 2012, at 3:03 AM and 6:20 AM. Additional review of MR29's MAR revealed nursing staff administered Percocet 5/325 mg one tablet PO on March 19, 2012, at 1:24 PM. Further review of MR29 revealed no documentation that nursing staff reassessed this patient's pain level following the administration of Morphine Sulfate 5 mg IV on March 17, 2012, at 9:05 PM; on March 18, 2012, at 2:18 AM, and on March 19, 2012, at 3:03 AM and 6:20 Amor the administration of Percocet 5/325 mg one tablet PO on March 19, 2012, at 1:24 PM.

6) Review on March 20, 2012, of MR31 revealed this patient's physician ordered Percocet 10/325 mg two tablets PO every four hours as needed for pain.

Review on March 20, 2012, of MR31's MAR revealed nursing staff administered Percocet 10/325 mg two tablets PO on March 16, 2012 at 4:48 AM, 9:20 AM, 1:44 PM and 4:36 PM. Further review of MR31 revealed no documentation that nursing staff reassessed this patient's pain level following the administration of Percocet 10/325 mg two tablets PO on March 16, 2012 at 4:48 AM, 9:20 AM, 1:44 PM, and 4:36 PM.

Interview with EMP1, EMP2, EMP3 and EMP4 on March 20, 2012, at approximately 3:15 PM confirmed nursing staff administered pain medication to MR3, MR4, MR6, MR13, MR29 and MR31. EMP1, EMP2, EMP3 and EMP4 confirmed nursing staff did not reassess MR3, MR4, MR6, MR13, MR29 and MR31's pain level following the administration of pain medications.

Continuing deficiency cited February 15, 2012.

Based on review of facility documents, medical records (MR) and staff interview (EMP) it was determined the facility failed to ensure all verbal orders were dated, timed, and signed by the ordering physician for three of 36 medical records reviewed (MR15, MR22, and MR27).

Findings include:

Review on March 21, 2012, of the "Schuylkill Medical Center South Jackson Street Medical Staff Rules and Regulations," last reviewed 2011, revealed "... Section 6 - Medical Records ... 6.6 Doctor's Orders: 6.6.1 Verbal/telephone orders for medication or treatment shall be accepted only under urgent circumstances when it is impractical for such orders to be given in a written manner by the responsible practitioner. ... The orders shall include the date, time and full signature of the person taking the order and shall be countersigned, dated and timed within 24 hours by a practitioner. ..."

1) Review on March 20, 2102, of MR15 revealed the physician gave a verbal order for nursing staff to transfer this patient to a medical surgical floor with the same medications and treatments, to discontinue the intravenous line, and to begin KDUR (a potassium supplement) 20 milliequivalents (mEq) orally each day. Further review of MR15 revealed the ordering physician did not sign, date or time the verbal orders.

Interview with EMP2 on March 20, 2012, at approximately 10:45 AM confirmed the physician did not sign, date or time the verbal orders given to nursing staff for MR15.

2) Review on March 20, 2012, of MR22 revealed the physician gave verbal orders on March 18, 2012, for nursing staff to administer Benadryl (antihistamine) 50 mg (milligram) PO (by mouth) one now, call lab - notify of blood reaction and the temperature of 100.2 Fahrenheit; to obtain a CBC (complete blood chemistry), haptoglobin (blood protein), LFT (liver function test) and chest x-ray in AM. Further review of MR22 revealed the ordering physician did not sign, date or time the verbal orders.

Interview with EMP5 on March 20, 2012, at approximately 11:45 AM confirmed the physician did not sign, date or time the verbal orders given to nursing staff for MR22.

3) Review on March 20, 2012, of MR27 revealed the physician gave a verbal order for nursing staff to consult the pulmonary (lung) service to see the patient. Further review of MR27 revealed the ordering physician did not sign, date or time the verbal orders.

Interview with EMP6 on March 20, 2012, at approximately 2:20 PM confirmed the physician did not sign, date or time the verbal order given to nursing staff of MR27.

Continuing deficiency cited February 15, 2012.

Based on review of facility documents, observation, and staff interview (EMP), it was determined that the facility failed to ensure trash and soiled linen were properly stored in the pediatric unit.

Findings include:

Review on March 21, 2012, of the facility's "Housekeeping Department-Infection Control" policy, last reviewed August 2011, revealed "Policy: To maintain a clean environment to minimize the risk of environmental transmission of microorganisms to patients, staff and visitors. Procedure: ... 6. Waste Disposal and Trash Containers ... B. Trash and infectious waste must not be allowed to accumulate on the floor of the soiled utility room. ... "

1) Tour on March 20, 2012, of the Pediatric unit revealed one bag of trash on the floor, a bag of trash on the base of the trash cart instead of being suspended on the frame of the cart, and a bag of soiled linen on the floor of the dirty utility room.

Interview with EMP7on March 20, 2012, at approximately 11:30 AM confirmed the bag of trash on the floor; the bag of trash on the base of the trash cart, and the bag of soiled linen on the floor in the dirty utility room on the Pediatric Unit.

2) Tour on March 20, 0212, of the facility's third floor soiled utility room revealed five bags of trash on top of lidded empty trash containers.

Interview with EMP8 and EMP9 on March 20, 2012, at approximately 10:30 AM confirmed the five bags of trash on top of lidded empty trash containers in the soiled utility room.

Continuing deficiency cited February 15, 2012.

Based on observation, review of facility documents and staff interview (EMP), it was determined that the facility failed to follow their established policy regarding washing hands following contact with a patient on contact isolation precautions (MR6).

Findings include:

Review on March 20, 2012, of the facility's "Isolation Precautions Policy and Procedure," last reviewed August 2011, revealed "To minimize and control the transmission of infections to patients, visitors and staff through appropriate patient placement and precautions. ... 2. Transmission Based categories ... C. Contact 1) Transmission occurs by direct body surface-to-body surface contact and physical transfer of the microorganism between a susceptible host and an infected or colonized person, or involves contact of a susceptible host with a contaminated intermediate object, usually inanimate. ... '

Observation on March 20, 2012, revealed a Contact Precaution stop sign posted on the outside of MR6's door instructing staff and visitors to "Reminder: Hand hygiene [washing hands or utilization of a foam or liquid hand sanitizer] must be performed before entering the room and following removal of PPE [Personal Protective Equipment] and leaving the patient's room. Use hand hygiene agent to clean hands prior to entering and after leaving patient room."

Observation on March 20, 2012, at approximately 10:00 AM revealed MR6's nurse call bell was ringing. Further observation revealed EMP11 and EMP12 enter MR6's room without performing hand hygiene. These employees touched the privacy curtain, the bed side rails and turned off MR6's nurse call bell. EMP11 and EMP12 then left this patient's room without performing hand hygiene. EMP11 proceeded to go to another patient room and EMP12 went to the nursing station. EMP11 and EMP12 did not perform hand hygiene following contact with MR6's environment.

Interview with EMP10 confirmed MR6 was on Contact Precautions; the sign posted on the entrance to this patient's room clearly instructed staff and visitors to perform hand hygiene when entering and leaving the room; EMP11 and EMP12 responded to MR6's ringing nurse call bell; and EMP11 and EMP12 did not perform hand hygiene following contact with MR6's environment.