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Based on record review, the facility failed to ensure that all drugs were administered under supervision of nursing in accordance with state laws which require physician orders for administration in one of eight sampled patients. (#1)

Findings:

A review of the medical record of patient #1 was performed. The patient presented to the Emergency Room on 1/22/11 at 11:18 AM, whereupon he received a rapid initial assessment. The subjective assessment was stated as: "Chest pain, SOB (shortness of breath), cough X 1 month. Denies fever". The Objective assessment read: "NAD (no acute distress) noted at pres, EKG done in triage office". From this point through 2:12 PM the patient remained in the lobby and received two additional assessments during the intervening time period.

A Triage Reassessment at 2:12 PM read: "Pt states his pain is fluctuating BTW (between) 2-4, pt states he has nitro. RN advised pt to take a nitro and advise on his pain. ... NAD noted. ... Pulse: 65; Respirations 14; Blood pressure 148/93; SPO2: 99. ... Pain /Discomfort Severity: 4. Condition: worsened; Disposition: Moved to treatment area". "Nitro", short for nitroglycerin, is a medication used to relieve acute chest pain. Therefore, as this entry was written, the patient was advised by the nurse to perform an action involving a medication. This action was beyond the purview of the nurse, as there was no physician orders to do such.

Nursing note on 1/22/11 at 2:14 PM read: "Pt taking a 0.4 mg nitro at pres will monitor". A nursing note at 2:24 PM read: "After 1st nitro pain dropped to a 2 but about 1 min later pt pain up to 4. Pt taking 3rd nitro. NAD noted". As with the first nitroglycerin administration, there was no evidence of any physician orders or involvement with these second and third administrations.

The act of advising a patient to take a medication once they are under their care, without physician orders for such, is a violation of standard nursing practices as ordained by State of Florida law.