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Based on record review, physician and staff interview, the off-campus department of the Hospital failed to ensure that one of one applicable Pediatric Patient's was immediately evaluated following a complaint of a medication overdose in November 2010.

The findings are as follow:

A young child was brought to the Pediatric Walk-In Center following the suspicion of an overdose of the Child's own medication at a day care center.

Review of the Child's Registration indicated the Child arrived at the Walk-In Center at 6 PM. There was no written documentation for the Child's chief complaint entered at the time of registration.

The Patient Flow Coordinator was interviewed in person on 11/29/10 at 1 PM. The Patient Flow Coordinator registered the Child at the Walk-In Center and informed the Mother it would be an hours wait. The Patient Flow Coordinator said the Mother was concerned the Child was usually hyperactive and not usually this quiet. The Patient Flow Coordinator said Triage Nurse/LPN was told the Child was given an overdose.

There was no documentation at the time of registration for the Child's chief complaint of a medication overdose. The Child was processed in the standard manner for any other walk-in patient which was drawing a lottery number.

There were no written Triage Policies for the Pediatric Walk-In Center which would distinguish the acuity levels which would require immediate assessment or the pediatric patient..

Continued review indicated one hour following registration, the Child was taken into the Pediatric Walk-In Center for Triage assessment at 7:10 PM.

Medical Assistant #1 was interviewed in person on 11/29/10 at 11:37 AM. Medical Assistant #1 was unaware as to the reason for the Child's visit to the Walk-In Center until the Child was brought into Triage of the Walk-In Center.

The Walk-In Center Triage Nurse/Licensed Practical Nurse was interviewed on 11/29/10 at 11:15 AM. The Triage Nurse/LPN said the Child came from registration to Triage without a diagnosis/chief complaint. The Triage Nurse/LPN called the Poison Control Center and the center recommended the Child be observed for an additional three hours.

The Triage Nurse/LPN failed to document the Child's chief complaint, the medication consumed and the time the medication was given. The Triage Nurse/LPN failed to document the Child's mental status, behaviors and/or condition. At approximately 7:52 PM, the Child was then taken to the Urgent Care/ED within the campus. The Triage Nurse/LPN failed to document the measures if any for the assessment of the Child and the reason for the transfer of the Child to the Urgent Care/ED within the campus.

It was not specifically clear as to why the Child was not transferred from the Walk-In Center to the Hospital for further medical management.

It was not specifically clear as to the time the Physician #1 at the Walk-In Center examined the Child.

Review of the Physician's Progress Note from the Walk-In Center indicated the Child had been reclassified as an Urgent Care Patient. Physician #1 documented the Progress Note at 9:32 PM (written after the Child had been transferred to the Urgent Care/ED within the campus).. The Progress Note indicated the Chief Complaint was an accidental overdose of the medication Quanfacine which had been given at a day care center. Physician #1 indicated the Child had been administered two one milligram tablets, three times a day instead of half tablets three times a day which was the regular daily dose. Physician #1 indicated the Child was positive for dizziness and "walking funny". Physician #1 indicated the Child was well appearing, cooperative with ataxia (unsteady) gait.

Physician #1 was interviewed by telephone on 11/29/10 at 12:04 PM. Physician #1 said the Patient was evaluated one to two hours after Triage. Physician #1 said the Triage Nurse/LPN kept an eye on the Child and Poison Control was called by the Triage Nurse/LPN. Physician #1 said the Child's vital signs and neurological signs were stable and the Child's pulse rate ranged between 60 to 75 beats per minute. Physician #1 said the Child was stable and very aware making comments throughout the visit. Physician #1 said the Child's Mother reported the Child was administered two tablets instead of half tablets of Guanfacine a medication used to treat ADD.

On 11/10/10 at 7:52 PM, the Child was taken to the Urgent Care/ED for further evaluation and arrangements were made for transfer to a Boston hospital and admission into the Pediatric Intensive Care Unit.

The Deputy Chief Medical Officer accompanied the Surveyor on the day of survey. the Deputy Chief Medical Officer said all children were evaluated in the Walk-In Center during the hours of operation and not taken to the Urgent Care/ED. The Deputy Chief Medical Officer said appointments were scheduled which were often made prior to arrival, as parents would call ahead of arrival. The Deputy Chief Medical Officer said in addition to the walk-in patients, children arrived for appointments with their primary care physicians.

The Off-Campus Walk-In Center lacked policies as an off-campus department for the appraisal of emergencies for the pediatric patient evaluated in the Walk-In Center.

Based on medical record review , physician and staff interview, one of one applicable Pediatric Urgent Care/ED record in its original form was not made available on the day of survey.

The findings are as follow:

On the day of survey to the Center, the Child's Urgent Care/ED record was requested and not made available to the Surveyor.

Both the Chief Medical Officer and the Senior VP of Clinical Services accompanied the Surveyor on the day of survey. Both said the original Urgent Care/ED record for the Child was not able to be located. The Chief Medical Officer said the original record may have been in the Chief Medical Officer's office.

Based on record review and staff interview, the Pediatric Walk-In Physician did not document the time of examination for one of one applicable Pediatric Patient medical records review for a complaint of a medication overdose in November 2010.

The findings are as follow:

The Child was brought into Triage in the Pediatric Walk-In Center at 7:10 PM

Review of the Physician's Progress Note from the Walk-In Center indicated the Child had been reclassified as an Urgent Care Patient. Physician #1 documented the Progress Note at 9:32 PM (written after the Child had been transferred to the Urgent Care/ED within the campus).. The Progress Note indicated the Chief Complaint was an accidental overdose of the medication Quanfacine which had been given at a day care center. Physician #1 indicated the Child had been administered two one milligram tablets, three times a day instead of half tablets three times a day which was the regular daily dose. Physician #1 indicated the Child was positive for dizziness and "walking funny". Physician #1 indicated the Child was well appearing, cooperative with ataxia (unsteady) gait.

Physician #1 was interviewed by telephone on 11/29/10 at 12:04 PM. Physician #1 said the Patient was evaluated one to two hours after Triage. Physician #1 said the Triage Nurse/LPN kept an eye on the Child and Poison Control was called by the Triage Nurse/LPN. Physician #1 said the Child's vital signs and neurological signs were stable and the Child's pulse rate ranged between 60 to 75 beats per minute. Physician #1 said the Child was stable and very aware making comments throughout the visit. Physician #1 said the Child's Mother reported the Child was administered two tablets instead of half tablets of Guanfacine a medication used to treat ADD.

Physician #1 did not document the specific time for the evaluation in the progress note for the Child with a complaint of a medication overdose.

Based on medical record review, physician and staff interview, the Pediatric Walk-In Center Triage Nurse/LPN failed to document the assessment and appropriate interventions for one of one Pediatric Patients brought to the Center with the suspicion of a medication overdose in November 2010.

The finding are as follow:

A young child was brought to the Pediatric Walk-In Center following the suspicion of an overdose of the Child's own medication at a day care center.

Review of the Child's Registration indicated the Child arrived at the Walk-In Center at 6 PM. There was no written documentation for the Child's chief complaint entered at the time of registration.

The Patient Flow Coordinator was inteviewed in person on 11/29/10 at 1 PM. The Patient Flow Coordinator registered the Child at the Walk-In Center and informed the Mother it would be an hours wait. The Patient Flow Coordinator said the Mother was concerned the Child was usually hperactive and not usually this quiet. The Patient Flow Coordinator said Triage Nurse/LPN was told the Child was given an overdose.

There was no documentation at the time of registration for the Child's chief complaint of a medication overdose. The Child was processed in the standard manner for any other walk-in patient which was drawing a lottery number.

There were no written Policies for the Walk-In Center to identify medical conditions that would require immediate attention for the pediatric population.

Continued review indicated one hour following registration, the Child was taken into thePediatric Walk-In Center Triage at 7:10 PM.

Medical Assistant #1 was interviewed in person on 11/29/10 at 11:37 AM. Medical Assistant #1 was unaware as to the reason for the Child's visit to the Walk-In Center until the Child was brought into Triage of the Walk-In Center.

The Walk-In Center Triage Nurse/Licensed Practical Nurse was interviewed on 11/29/10 at 11:15 AM. The Triage Nurse/LPN said the Child came from registration to Triage without a diagnosis/chief complaint. The Triage Nurse/LPN called the Poison Control Center and the center recommended the Child be observed for an additional three hours.

The Triage Nurse/LPN failed to document the Child's chief complaint, the medication consumed and the time the medication was given. The Triage Nurse/LPN failed to document the Child's mental status, behaviors and/or condition. At approximately 7:52 PM, the Child was then taken to the Urgent Care/ED within the campus. The Triage Nurse/LPN failed to document the measures if any for the assessment of the Child and the reason for the transfer of the Child to the Urgent Care/ED within the campus.

There was no documentation the Child was referred to the medical provider/Physician #1 in the Pediatric Walk-In Center.