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Based on medical record review, policy review and staff interview, the facility failed to ensure verbal physician orders were authenicated per policy for one of 10 medical records reviewed. (Patient #6)

Findings include:

The medical record review for Patient #6 was completed on 04/17/13. The four year old patient presented to the emergency department on 04/02/13 unresponsive and not breathing. Cardiopulmonary resuscitation was initiated in treatment room four at 10:55 PM. At 11:52 PM, Staff C documented the patient's glucose as 25. Staff D documented dextrose was administered via intraosseous infusion (the process of injecting directly into the marrow of a bone to provide a non-collapsible entry point into the systemic venous system). At 12:30 AM, Staff C documented 2.4 units of regular insulin and 48 milliliters of dextrose were administered intravenously. At 12:27 AM, Staff C documented 500 milligrams of calcium chloride as administered. At 12:28 AM, Staff C documented 40 milliequivalents of sodium bicarbonate was administered. At 12:02 AM, Staff C documented two milligrams/kilogram of sodium bicarbonate was administered. The medical record did not contain a physician order for the calcium chloride, sodium bicarbonate, insulin and dextrose administration.
On 04/17/13 at 2:30 PM, Staff C was interviewed. Staff C stated he/she was assigned to scribe during the patient's emergency treatment. Staff C stated he/she documented the medications on the emergency services nurse notes due to Staff H giving verbal orders for the registered nurse to administer the medications. Staff C stated 48milliliters of regular insulin was administered at 11:54 PM.
On 04/17/13 at 2:15 PM, Staff I was interviewed. Staff I stated he/she was present in the treatment rom of patient #6 during the entire time emergency treatment was being provided. Staff I stated he/she heard the nurse repeat-back the insulin and dextrose orders to the physician for clarification.
On 04/17/13, Staff D and Staff E were interviewed. Both stated a physician is always present during emergency treatment. They stated all medications during emergency treatment are administered after a physician gives a verbal order for the medications.
The facility Verbal Orders policy #3007 was reviewed on 04/17/13. The policy stated there may be urgent situations where the responsible medical staff member cannot practically record the orders. A registered nurse may record the items ordered and the medical staff member authenticates the order immediately once conditions allow (an example would be the inventory of medications used in managing cardiopulmonary arrest).