HospitalInspections.org

Based on policy review, record review and staff interviews, it was determined the facility failed to administer medications as ordered and per policy, for 4 (#1, #4, #6, #8) of 10 sampled patients.
Findings include:
1. The facility' policy, Medication Administration Times with effective date, 07/01/2013 states, "the definition of Time Critical Medications are medications identified in this policy that due to the medication or the patient's diagnosis must be given at the exact time or within 30 minutes before or after the scheduled time. Time Critical scheduled medications are Medications with a dosing schedule of every 4 hours or more frequent " .

2. A review of the medical record for patient #4 revealed the Physician order dated 3/16/14 "Ipratropium/Albuterol Sulfate 0.5-3mg/3ml ampule Neb per dose inhaler every 4 hours ". A review of the electronic Medication Administration Record (e-MAR) revealed the scheduled medication was to be administered by Respiratory Therapy. On 3/17/14 the MAR revealed zero of two doses were administered outside the 30 minute scheduled time-frame. On 3/18/14 the MAR revealed five of six doses were administered outside the 30 minute scheduled time-frame. On 3/19/14 the MAR revealed two of six doses were administered outside the 30 minute scheduled time-frame. These findings were confirmed by Staff A.

3. A review of the medical record for patient #8 revealed the Physician order dated 02/06/14 "Ipratropium/Albuterol Sulfate 0.5-3mg/3ml ampule Neb per dose inhaler every 4 hours ". A review of the electronic Medication Administration Record (e-MAR) revealed the scheduled medication was to be administered by Respiratory Therapy. On 02/6/14 the e-MAR revealed zero of one dose was administered outside the 30 minute scheduled time-frame. On 02/07/14 the e-MAR revealed two of six doses were administered outside the 30 minute scheduled time-frame. On 2/8/14 the e-MAR revealed two of five doses were administered outside the 30 minute scheduled time-frame. These findings were confirmed by Staff A.

4. Review of the electronic medical record for patient #1 revealed orders indicating the patient left the floor three times a week mid morning to receive dialysis on a different floor in the hospital. Review of his orders also revealed the patient was to receive a breathing treatment (ipratr-albuterol 3 milliliters, every four hours while awake) scheduled to be given at 0800, 1200, 1600, and 2000.
Review of the electronic medication administration record for this patient revealed on 03/11/14, 03/13/14, and 03/18/14 , for the 1200 dose of the breathing treatment, the medication had not been given and the documented reason was "patient not available". Interview with the Unit Director, staff A, on 03/20/14 at 9:50 a.m., revealed the patient left the floor about 10 a.m. for dialysis and he wasn't available on the floor for the Respiratory Therapist (RT) to administer the breathing treatment. She provided an order to "hold all blood pressure medications prior to dialysis", but there was no doctors order to hold, or not give, the breathing treatments related to being off of the floor for up to four hours to receive dialysis. She confirmed there were no notes by either the nurses or the RT indicating the doctor had been made aware of the missed breathing treatments due to the patient being off the floor three times during the week.
Further review revealed the Ipratr-Albuterol 3 ml every four hours was not being given within thirty minutes of scheduled time, per the policy. On 03/17/14 and 03/18/14 two of four doses were administered outside of the thirty minute time frame. On 03/19/14 one of four doses were administered outside of the thirty minute time frame.

5. Review of the medical record for patient # 6 revealed physician orders upon admission on 02/09/14 that included the use of an Incentive Spirometer and an Acapella device. Orders included "deep breaths and coughs ten times a day."
The order for the Acapella device was acknowledged by the Respiratory Therapist on 02/09/14 at 13:24 p.m., but did not include the frequency of use and description of what the physician expected ("deep breaths and coughs ten times a day.")
Review of the electronic record did not reveal either nursing or RT documented the patient's use of the breathing devices.
Interview with the Director of Respiratory Services, on 03/20/14 at 12:00 p.m., confirmed that after educating the patient on the use of both the Incentive Spirometer and the Acapella device, there should be documentation that the patient was using the device, per the order 'ten times a day.'