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Based on interviews and review of clinical records, it was determined that the Registered Nurse failed to evaluate and supervise care for one (#1) of three records reviewed for the immunocompromised patient. This practice does not ensure goals are met.

Findings include:

1, Patient #1 presented to the Emergency Room on 2/11/10 with a chief complaint of a fever and and cough. The patient had a history that included cancer and was receiving chemotherapy and radiation. The History and Physical dated 2/11/10 indicated the patient was immuno compromised. The physician's progress note on 2/11/10 revealed patient was immuno compromised. Physician admission orders dated 2/11/10 at 1:53 p.m. instructed for Medical bed with no isolation marked. Nursing diagnosis entry dated 2/11/10 at 10:16 a.m. indicated a "Potential for Infection". Nursing documentation noted the patient was admitted on 2/11/10 at 2:20 p.m. to a semi-private room. There was no evidence of the Registered Nurse evaluating the need for a private room or reverse isolation room for the patient's immuno compromised condition.

Interview was conducted with the unit Charge Nurse for 2 North at 1:30 p.m. on 4/2/10. The Charge Nurse stated that a patient who is immuno compromised will be placed on neutropenic precautions and reverse isolation. Interview with a Registered Nurse (RN) on 2 North at on 4/2/10 revealed when a patient needs isolation; the Charge Nurse is notified and will arrange for a room.
Interview with the Infection Control Director at 3:15 p.m. on 4/2/10 revealed that usually the physician will order isolation precautions. The interview noted that all nurses have the capability of placing patients on isolation and that reverse isolation precautions falls under the hospital policy for Infection control under "Protective Environment". Interview with the Chief Nursing Officer and Risk Manager on 4/2/10 revealed that the patient being immuno compromised was documented throughout the chart and that the patient should have been placed in isolation.

Based on policy and record reviews and interview it was determined the facility failed to ensure that medications were administered in accordance with physicians orders for two (#1, #2) of 3 records reviewed. This practice does not promote safe administration of medications.

Findings include:

1. Patient's #1 Medication Administration Record (MAR) for 2/12/10 thru 2/13/10 revealed intravenous (IV) antibiotics were ordered to be given every 6 hours. The intravenous antibiotics ordered for 8:00 a.m. were not given until 2:04 p.m. The MAR showed reason the medication was given late was "patient preference". The antibiotic dose that was due at 2:00 p.m. was given at 11:45 p.m. The MAR indicated the reason for the late administration was "nurse triaged elsewhere" . The 2:00 a.m. dose was not given until 6:55 a.m. The reason was "new order".

The MAR for 2/12/10 thru 2/13/10 revealed Humibid was to be given by mouth twice daily. The dose for 10:00
p.m. was given at 11:43 p.m. due to "nurse triaged elsewhere". The scheduled 10:00 a.m. dose for 2/13/10 was given early at 6:54 a.m., the reason "nurse triaged elsewhere".


2. Patient #2's physician order dated 2/6/10 at 4:20 p.m. instructed for Solumedrol to be given IV every 6 hours. Review of the MAR for 2/8/10 thru 2/9/10 showed only 1 of 4 scheduled doses of Solumedrol was administered. On 2/10/10 intravenous antibiotics that were scheduled for 10:00 a.m. were administered at 1:53 p.m. The MAR show the reason for the late administration was "patient preference".

The facility ' s policy for Administration of Medications #NS-242, effective 5/03 revealed under the Procedure category #11- All scheduled medications are to be administered 30 minutes before or after the scheduled dose regimen per the MAR.

Interview with the Risk Manager and Chief Nursing Officer at 4:00 p.m. on 4/2/10 confirmed, after they had
reviewed both patient's records, the medications were not administered as ordered.

Based on policy, procedures, and clinical record reviews and staff interview, it was determined that the facility failed to implement facility guidelines for the immuno compromised patient for protective isolation measures for 1 (#1) of 3 sampled patients. This practice fails to ensure a protective environment for the immuno compromised patients.

Findings includes:

1. Patient #1 presented to the Emergency Room on 2/11/10 with a chief complaint of fever. The History and Physical dated 2/11/10 indicated the patient was immuno compromised. The patient had a history that included multiple myeloma, bone cancer and was receiving chemotherapy and radiation. The physician's progress note on 2/11/10 revealed patient was immune compromised. Physician admission orders dated 2/11/10 at 1:53 p.m. instructed for Medical bed with no isolation marked. Nursing diagnosis entry dated 2/11/10 at 10:16 a.m. indicated a "Potential for Infection". Nursing documentation noted the patient was admitted on 2/11/10 at 2:20 p.m. to a semi-private room. There was no evidence of the Registered Nurse evaluating the need for a private room or reverse isolation room for the patient's immune compromised condition.

Interview with the unit Charge Nurse for 2 North was conducted at 1:30 p.m. on 4/2/10. The Charge Nurse stated that a patient who is immune compromised will be placed on neutropenic precautions and reverse isolation. Interview with the Infection Control Director at 3:15 p.m. on 4/2/10 revealed that usually the physician will order isolation precautions. The interview noted that all nurses have the capability of placing patients on isolation and that reverse isolation precautions falls under the hospital policy for Infection control under "Protective Environment".

Review of Policy and Procedure " Infection Control " #IC4.2 dated 3/09, under " Protective Environment " provided for guidelines to be used for the immune compromised patient. The guidelines included special room air filtering. The clinical record did not reveal evidence of the patient being placed in a protective environment on admission.
Interview with the Chief Nursing Officer and Risk Manager on 4/2/10 revealed that the patient being immune compromised was documented throughout the chart and that the patient should have been placed in isolation.