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Based on interview, record review and review of the facility's policy, it was determined the facility failed to ensure patients received medications, in a timely manner, for five (5) out of ten (10) sampled patients (Patients #4, #6, #7, #8 and #10). The facility failed to ensure Patients #4, #6, #7, #8 and #10 received their medications as ordered.

The findings include:

Review of the facility's policy titled, "Medication Administration-Administering and Charting Medications" (Revised 12/11) revealed timing of medication administration took into account the nature of the prescribed medication, specific clinical applications, and patient needs. Medications would be classified as eligible or not eligible for scheduled dosing times. Medications considered not eligible for scheduled dosing times required exact or precise timing of administration (examples may include stat doses, first time or loading doses, one-time doses and others). Interview, on 05/24/12 at 4:45 PM, with the Chief Nursing Officer revealed she expected employees to follow the facility's policies and medications should be given timely. She further stated medications orders in the Emergency Department should be given immediately when ordered.

1. Record review revealed the facility admitted Patient #4 to the Emergency Department with diagnoses which included Chest Pain.

Review of the Physician's Orders revealed an order, dated 05/08/12 at 8:49 PM for Catapres 0.1 milligram (mg) by mouth times 1. Review of the Orders revealed the medication was documented as given at 9:33 PM. Further review revealed an order written at 9:59 PM for Lopressor 5 mg Intravenously (IV) every two (2) minutes times three (3) doses; however, review of the documentation revealed the Lopressor was given to Patient #4 at 10:28 PM. Further review revealed an order written at 9:39 PM for Nitroglycerin 0.4 mg every five (5) minutes times three (3) doses; however review of the documentation revealed the first dose of Nitroglycerin was given at 10:23 PM.

Further record review revealed Patient #4 was diagnosed with Acute Myocardial Infarction and was transferred to another hospital.

2. Record review revealed the facility admitted Patient #6 to the Emergency Department on 05/07/12 with diagnoses which included left hip, left groin, left side and back pain from a fall and Pelvic Fracture.

Review of the Physician's Orders revealed an order, written on 05/07/12 at 11:55 PM, for Morphine 2 grams (g) IV and Zofran 4 mg IV; however review of the documentation revealed the Morphine and Zofran were given from 1:23 AM to 1:24 AM.

3. Record review revealed the facility admitted Patient #7 to the Emergency Department on 05/11/12 with diagnoses which included Non-displaced Subcapital, Right Hip Fracture, Status Post Fall, Hypothyroid, Hypertension (HTN), Cardiac Disease with Pacemaker and Alzheimer's.

Review of Patient #7's Emergency Department (ED) medical record revealed the patient arrived at the hospital complaining of right hip pain due to a fall at home.

Review of the Initial Interview revealed Patient #7 arrived at the ED with intravenous (IV) access, by ambulance personnel.

Review of the Physician's Orders revealed an order written on 05/11/12 at 11:42 AM, for Morphine 2 mg IV times 1 dose and Zofran 4 mg IV times 1 dose to be given to Patient #7. Review of the documentation revealed Zofran was not administered to Patient #7 until 5:44 PM and the Morphine not was given until 5:46 PM to 5:48 PM.

4. Record review revealed the facility admitted Patient #8 to the Emergency Department on 05/14/12 with diagnoses which included Chest Pain and Acute Myocardial Infarction.

Review of the Physician's orders revealed an order written on 05/14/12 at 10:16 PM, for Gastrointestinal (GI) cocktail by mouth, Nitroglycerin (NTG) 0.4 mg sublingual times three (3) doses and Protonix 40 mg IV. Review of the documentation revealed Protonix was given from 11:05 PM to 11:06 PM, the GI Cocktail was given at 11:07 PM and the NTG was given at 11:08 PM.

Further record review revealed Patient # 8's health status worsened at 11:30 PM and the patient was diagnosed with Acute Myocardial Infarction and was transferred to another hospital.

5. Record review revealed the facility admitted Patient #10 to the Emergency Department on 05/21/12 with diagnoses which included back pain from a fall and Vertebral Fracture.

Review of the Physician's Orders dated 05/21/12 at 2:47 PM revealed an order for Dilaudid 0.5 mg IV and insertion of a Foley Catheter. Review of the documentation revealed Registered Nurse (RN) #1 documented the Foley Catheter was placed at 3:15 PM; however, the Dilaudid was not given until 4:23 PM to 4:25 PM. Continued review revealed another order written at 4:48 PM for Rocephin 1 g IV and Potassium Chloride (KCL) 40 mEq by mouth. Review of the documentation revealed the KCL was given, to Patient #10, prior at 5:40 PM and the Rocephin was not given until 6:15 PM.

Interview, on 05/24/12 at 9:30 AM, with RN #1 revealed she thought the facility's policy was to give medications within thirty (30) minutes after the order was written. She stated that one and a half (1 1/2) hours was too long to wait to give Antibiotics to a patient; however, she didn't know what she was doing at the time. She further stated she should have given the pain medications quicker because the patient had a fracture. She further stated she should have given the Dilaudid prior to placing the Foley Catheter. Continued interview revealed she should have followed the facility's policy related to medication administration.

Interview, on 05/24/12 at 11:25 AM, with the Emergency Department Manager revealed the facility's policy indicated the first doses and stat medications should be given when the orders were written. If the medications were not first doses they should be given within thirty (30) minutes after the order was written. Further interview revealed the medications should have been given prior to the catheter placement.

Interview, on 05/24/12 at 2:10 PM, with the Risk Manager/ Infection Control Nurse revealed prior to the current policy, medications were to be given within one (1) hour; however, the new policy indicated medications should be given within thirty (30) minutes of the order. She further stated it was in the best interest of the patient to give medication quickly and it appeared Patient #4's, #6's, #7's, #8's and #10's medications should have been given with immediacy, as soon as the orders were written.