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Based on medical record review, observation, staff interview, and policy review, the facility failed to ensure a registered nurse supervised and evaluated the nursing care (A395). The facility failed to ensure prescribed medications were administered per practitioner orders (A405).

Based on medical record review, observation, staff interview, and policy review, the facility failed to ensure a registered nurse supervised and evaluated the nursing care for one of ten medical records reviewed (Patient #6). The facility census was 89.

Findings include:

Review of the policy titled, Laboratory Services Number: CS-200.24, revised 02/22, revealed a STAT order specimen is to be collected within an hour and results available within (4) four hours of the specimen collection.

Review of the policy titled, Nursing Orders Number CS-200.393, revised 03/22, revealed in order to allow Registered Nursing staff to function within the full scope of their practice and in a manner that assures continuous quality patient care, based on assessment may implement nursing orders relative to changing or implementing a level of precautions. The Registered Nurse may initiate infection control protocol such as placing a patient in isolation for suspicion of either an infectious communicable disease such as influenza, or threat of risk of spreading infestations such as bed bugs. The medical provider will be contacted within one hour for notification of the change of condition and to obtain an order for the appropriate infection control protocol.

Review of the medical record for Patient #6 revealed a voluntary admission to the inpatient psychiatric facility on 08/04/22 for psychosis/bizarre behaviors. Review of the intake infectious disease screening on 08/04/22 at 5:02 PM revealed a viral/respiratory screen for symptoms of COVID-19. The patient reported no symptoms of COVID-19 upon admission to the facility. On 08/08/22 at 12:55 PM the patient was seen by the Certified Nurse Practitioner with a chief compliant of a fever, headache, and sore throat that started the prior day. On assessment the patient's temperature was 99.2, heart rate 125, and oxygen saturation 94 % on room air. Review of the written orders on 08/08/22 at 1:05 PM revealed Tylenol 650 milligrams (mg) every four hours as needed for pain/fever, Cepacol throat lozenges every two hours as need for sore throat, and a STAT COVID-19 test to be completed.

Review of the respiratory virus screening results completed on 08/08/22 at 6:46 PM, five hours and 41 minutes after the STAT order was written, revealed the patient was positive for the COVID-19 virus. The nurse checked a box on the screening form that the provider was notified on 08/08/22 at 7:30 PM. The box indicating the patient was placed on transmission based precautions was not checked. There was no evidence additional physician orders were received regarding infection control protocols.

Further review of nursing documentation dated 08/08/22 at 10:13 PM revealed the patient reported feeling cold and unable to properly breathe. Review of the vitals signs assessment sheet revealed vital signs were not obtained until the following morning on 08/09/22 at 10:00 AM.

A tour was conducted on the intensive treatment unit on 08/09/22 at 11:03 AM where the patient was assigned to room 507/A. There was no personal protective equipment available to staff located outside the patient's room.

Staff D confirmed these findings in an interview on 08/09/22 at 12:38 PM.

Based on medical record review, staff interview, and policy review, the facility failed to ensure prescribed medications were administered per practitioner orders for two of ten medical records reviewed (Patient #1 and #5). The facility census was 89.

Findings include:

Review of the policy titled, Medication Administration Number CS.200.28, revised 03/22, revealed facility staff administers medication in an efficient, safe, and accurate manner according to hospital policy and national patient safety goals. Medications must be administered by the established standard drug administration schedule of the hospital, unless otherwise specified by physician order.

1. Review of the medical record for Patient #1 revealed a past mental health history of bipolar disorder, depression, and anxiety who presented to a local emergency department for symptoms of mania. The patient was transferred from the emergency department after being medically cleared and voluntarily admitted to the inpatient psychiatric hospital on on 06/11/22 at 8:25 AM for further evaluation/treatment. Review of the initial nursing assessment on 06/11/22 at 9:28 AM revealed the patient had a history of hypertension with a documented blood pressure of 140/70.

Review of the history and physical examination completed on 06/11/22 at 11:50 AM revealed a medical history to include hypertension. Prescribed medications included Norvasc 5 milligrams (mg) (calcium channel blocker used to treat high blood pressure) daily by mouth. Review of the written orders dated 06/11/22 at 2:47 PM revealed an order to give Norvasc now. The patient's blood pressure was noted to be 140/70 at the time of assessment. Review of the medication administration record revealed Norvasc 5 mg by mouth was not administered to the patient until 06/12/22 at 9:00 AM.

2. Review of the medical record for Patient #5 revealed an admission date of 06/08/22 with a diagnosis of suicidal ideation. Review of the history and physical completed on 06/09/22 at 11:35 AM revealed the patient reported a history of constipation and had not had a bowel movement in a week. Review of the written orders dated 06/09/22 at 12:10 PM revealed Miralax 17 grams (gm) by mouth daily, Magnesium Citrate give 1/2 bottle and may repeat in two hours if no results, and Colace 100 mg by mouth daily. Review of the medication administration record revealed no documentation the Magnesium Citrate was never administered. The Miralax 17 gm was not administered until 06/10/22 at 9:00 AM and the Colace 100 mg was not administered until 06/11/22.

On 06/09/22 at 4:41 PM an order was placed for a Dulcolax suppository 10 mg rectally give once now. Review of the medication administration record revealed no documentation the Dulcolax suppository was administered.

Staff E confirmed the above findings in an interview on 08/10/22 at 5:12 PM.

This deficiency substantiates Substantial Allegation OH00134069.