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HCA FLORIDA OSCEOLA HOSPITAL
MEDICAL STAFF BYLAWS
Tag No.: A0353
Based on interview, record review and a review of facility medical staff by-laws, the facility failed to ensure the enforcement of its medical staff by-laws regarding the response times of physicians called for consultation for 1 of 10 sampled patients (#1).
Finding:
A review of the medical record of patient #1 was performed. The patient was admitted to the hospital on 5/08/13 at 2:50 PM. A nurse's note of 5/09/13 at 10:45 PM read, "Dr. ... consulted through answering service. Awaiting call back." Orders for a consult by Dr ... were entered on the computer at 10:47 PM on 5/09/13. Another nurse's note of 5/11/13 at 8:45 AM read, "Placed call to Dr...re: consult and plan of care. Awaiting return call." A physician's consultation note for service on 5/11/13 was dictated by the physician on 5/13/13 at 8:27 PM.
Regarding physician responses to consultation requests, a review of "Medical Staff Rules and Regulations" revealed the following: "The physician being consulted will evaluate the patient within 24 hours ...." The facility was in violation of this requirement. The order had been placed on 5/09/13 at 10:47 PM and the patient was not seen by the consulting physician until 5/11/13, at an unknown point between 8:45 AM and 8:27 PM.
During an interview of the Director of Quality on 7/30/13 at approximately 4:30 PM, she confirmed the finding.
STANDING ORDERS FOR DRUGS
Tag No.: A0406
Based on interview and record review, the facility failed to ensure that orders for drugs in the form of controlled pain medications were documented in an accurate manner by the physician who signed them for 1 of 10 sampled patients (#1).
Findings:
A review of the medical record of patient #1 was performed. The patient was admitted to the hospital on 6/11/13 and discharged at 7:31 PM on 6/14/13. Discharge medications ordered by the physician included Percocet and Dilaudid. A photocopy of a script for Dilaudid and Percocet was found in the medical record. In the lower right corner of the script was the following text: "Not valid for controlled substances." These two medications are controlled substances. Therefore, the patient would not have been able to fill the prescriptions as written.
During an interview of the Director of Quality on 7/30/13 at approximately 4:30 PM, she confirmed the finding.