HospitalInspections.org

Based on record review and interview the facility failed to track, analyze and determine the cause of the late administration of antibiotics for patients in the facility's Emergency Department, placing patients at risk for delayed treatment.

Findings include:

Review of the facility provided document Medication Administration Policy and Procedure (dated February 2016) reflected "This policy applies to the nursing staff ...and all who are involved in the medication administration process ...to assure the safe and accurate administration of medications ...the first dose must be administered as soon as possible ..."

Review of Patient #1's medical record revealed an admission to the Emergency Department (ED) on 8/1/16. ED Physician's Orders dated 8/1/16 reflected:
Vancomycin (an antibiotic) 1500 mg (milligram) Now at 2:33 p.m., the administration time was on 8/2/16 at 4:40 a.m., 14 hours later.
Zosyn (an antibiotic) 3.375 gm (grams) Now at 5:40 a.m., the administration time was at 7:41 p.m., 2 hours later.

Review of Patient #3's medical record revealed an admission to the Emergency Department (ED) on 8/2/16. ED Physician's Orders dated 8/2/16 reflected:
Vancomycin (an antibiotic) 1 gm (gram) Now at 3:44 a.m., the administration time was on 8/2/16 at 5:16 a.m., 1.5 hours later.

Review of Patient #4's medical record revealed an admission to the Emergency Department (ED) on 8/2/16. ED Physician's Orders dated 8/3/16 reflected:
Vancomycin (an antibiotic) 1 gm (gram) Now at 12:07 a.m., the administration time was on 8/3/16 at 1:52 a.m., 1.5 hours later.
Zosyn (an antibiotic) 4.5 gm (grams) Now on 8/2/16 at 8:15 p.m., the administration time was on 8/3/16 at 12:19 a.m. 4 hours later.

Review of Patient #5's medical record revealed an admission to the Emergency Department (ED) on 8/4/16. ED Physician's Orders dated 8/4/16 reflected:
Levofloxacin (an antibiotic) 750 mg Now at 12:39 a.m., the administration time was on 8/4/16 at 4:24 p.m., 4 hours later.
Zyvox (an antibiotic) 600 mg Now on 8/4/16 at 2:00 p.m., the administration time was on 8/4/16 at 4:24 p.m., 2.5 hours later.

Review of Patient #6's medical record revealed an admission to the Emergency Department (ED) on 8/4/16. ED Physician's Orders dated 8/4/16 reflected:
Vancomycin (an antibiotic) 1 gm (gram) Now at 2:24 a.m., the administration time was on 8/4/16 at 3:48 a.m., 1.25 hours later.
Aztreonam (an antibiotic) 2 gm (grams) Now on 8/4/16 at 2:24 p.m., the administration time was on 8/4/16 at 5:48 p.m., 3.25 hours later.

Review of Patient #12's medical record revealed an admission to the Emergency Department (ED) on 6/2/16. ED Physician's Orders dated 6/2/16 reflected:
Zosyn (an antibiotic) 4.5 gm (grams) Now on 6/2/16 at 11:59 p.m., the administration time was on 6/3/16 at 2:43 a.m., 2.5 hours later.

During an interview on 9/7/16 at 10:10 a.m., in a conference room, Staff #15, Pharmacy Director stated, "We don't have an exact policy for the timing of Now medications, typically it means within an hour...."

During an interview on 9/7/16 at 12:00 p.m. in the ED Staff #16, ED RN stated, "In the ED, we get an order and we carry it out as soon as possible ...when the patient is held in the ED (waiting for an inpatient bed) the orders that are timed for later are a little more difficult to see on the computer ...there isn't anything to remind us to give the medication....we have to prioritized the care...sometimes you will have two ICU(Intensive Care) patients a medical surgical patient and an ambulance coming in, it can be a little difficult at times..."

During an interview on 9/7/16 at 12:20 p.m. in the ED Staff #17, ED RN stated, "Now means ...within an hour...when we get a new order the computer pops up we have an order ....once you review it, it disappears, you have to keep going back into the computer to see the order...sometimes the computer will drop orders, you can't see it unless you go back to look at the order...when we are holding a patient in the ED and an ambulance comes in, we have to prioritize the patients, sometimes the antibiotic has to wait until the ambulance patient is stabilized."

During an interview on the morning of 9/7/16, in the conference room, Staff #3, Quality Director confirmed the findings.

Based on interview and record review the facility failed to ensure the staffs adherence to the timely, safe and effective medication administration when (6) out of (12) Emergency Department patient's antibiotics administered late. (Patients #1, 3, 4, 5, 6 and 12)
Findings Include:
Review of the facility provided document Medication Administration Policy and Procedure (dated February 2016) reflected "This policy applies to the nursing staff ...and all who are involved in the medication administration process ...to assure the safe and accurate administration of medications ...the first dose must be administered as soon as possible ..."

Review of Patient #1's medical record revealed an admission to the Emergency Department (ED) on 8/1/16. ED Physician's Orders dated 8/1/16 reflected:
Vancomycin (an antibiotic) 1500 mg (milligram) Now at 2:33 p.m., the administration time was on 8/2/16 at 4:40 a.m., 14 hours later.
Zosyn (an antibiotic) 3.375 gm (grams) Now at 5:40 a.m., the administration time was at 7:41 p.m., 2 hours later.

Review of Patient #3's medical record revealed an admission to the Emergency Department (ED) on 8/2/16. ED Physician's Orders dated 8/2/16 reflected:
Vancomycin (an antibiotic) 1 gm (gram) Now at 3:44 a.m., the administration time was on 8/2/16 at 5:16 a.m., 1.5 hours later.

Review of Patient #4's medical record revealed an admission to the Emergency Department (ED) on 8/2/16. ED Physician's Orders dated 8/3/16 reflected:
Vancomycin (an antibiotic) 1 gm (gram) Now at 12:07 a.m., the administration time was on 8/3/16 at 1:52 a.m., 1.5 hours later.
Zosyn (an antibiotic) 4.5 gm (grams) Now on 8/2/16 at 8:15 p.m., the administration time was on 8/3/16 at 12:19 a.m. 4 hours later.

Review of Patient #5's medical record revealed an admission to the Emergency Department (ED) on 8/4/16. ED Physician's Orders dated 8/4/16 reflected:
Levofloxacin (an antibiotic) 750 mg Now at 12:39 a.m., the administration time was on 8/4/16 at 4:24 p.m., 4 hours later.
Zyvox (an antibiotic) 600 mg Now on 8/4/16 at 2:00 p.m., the administration time was on 8/4/16 at 4:24 p.m., 2.5 hours later.

Review of Patient #6's medical record revealed an admission to the Emergency Department (ED) on 8/4/16. ED Physician's Orders dated 8/4/16 reflected:
Vancomycin (an antibiotic) 1 gm (gram) Now at 2:24 a.m., the administration time was on 8/4/16 at 3:48 a.m., 1.25 hours later.
Aztreonam (an antibiotic) 2 gm (grams) Now on 8/4/16 at 2:24 p.m., the administration time was on 8/4/16 at 5:48 p.m., 3.25 hours later.

Review of Patient #12's medical record revealed an admission to the Emergency Department (ED) on 6/2/16. ED Physician's Orders dated 6/2/16 reflected:
Zosyn (an antibiotic) 4.5 gm (grams) Now on 6/2/16 at 11:59 p.m., the administration time was on 6/3/16 at 2:43 a.m., 2.5 hours later.

During an interview on 9/7/16 at 10:10 a.m., in a conference room, Staff #15, Pharmacy Director stated, "We don ' t have an exact policy for the timing of Now medications, typically it means within an hour ...."
During an interview on 9/7/16 at 12:00 p.m. in the ED Staff #16, ED RN stated, "In the ED, we get an order and we carry it out as soon as possible ...when the patient is held in the ED (waiting for an inpatient bed) the orders that are timed for later are a little more difficult to see on the computer ...there isn ' t anything to remind us to give the medication .... we have to prioritized the care ...sometimes you will have two ICU(Intensive Care) patients a medical surgical patient and an ambulance coming in, it can be a little difficult at times ..."

During an interview on 9/7/16 at 12:20 p.m. in the ED Staff #17, ED RN stated, "Now means ...within an hour ...when we get a new order the computer pops up we have an order ....once you review it, it disappears, you have to keep going back into the computer to see the order ...sometimes the computer will drop orders, you can't see it unless you go back to look at the order ...when we are holding a patient in the ED and an ambulance comes in, we have to prioritize the patients, sometimes the antibiotic has to wait until the ambulance patient is stabilized."

During an interview on the morning of 9/7/16, in the conference room, Staff #3, Quality Director confirmed the findings.

Based on observation, interview and record review the facility failed to maintain a clean and separate area for medication preparation to minimize the possibility of contamination when the Pharmacy staffs were eating in the pharmacy and washing dirty dishes in the pharmacy hand sink.
Findings Include:
Observations made on 9/6/16 at 11:30 a.m. in the facility's pharmacy revealed the handwashing sink adjacent to medications was being used to wash dirty dishes. An open trash can next to medication shelves had food scrapings and discarded gum stuck to the mouth of the open trash can. A second trash can, next to the Intravenous preparation area had, an opened and eaten, discarded cup of vanilla pudding sitting in the full trash can.
During an interview on 9/6/16 at 11:30 a.m. in the facility's pharmacy Staff #18, Pharmacy Clinical Manager stated, "We don't have a breakroom so we have a table set up in the back where the staff can eat. We try to keep it separated ...." Staff #18 confirmed the findings.
During an interview on 9/7/16 at 10:10 a.m., in a conference room, Staff #15, Pharmacy Director stated, "We don't have a policy about eating in the Pharmacy..."