HospitalInspections.org

Based on document review and interview, it was determined, for 2 of 10 clinical records reviewed (Pt. #1 and 7), the hospital failed to ensure medications were administered timely in accordance with physicians' orders.

Findings include:

1. On 8/24/15 at 2:00 PM, hospital policy # MED-001, titled, "Medications - Administration", revised August 2013, was reviewed. The policy required, "F. Standard Medication Administration Times... 3. Non-time critical scheduled medications... a. Daily, weekly, or monthly medications: administer within 2 hours before or after the scheduled time. b. Medications prescribed more frequently than daily... within 1 hour before or after the scheduled time."
2. On 8/26/15 at 2:45 PM, an interview was conducted with the Manager (E #1) of 6 SW (oncology unit). E #1 stated medications scheduled for 2 times a day (BID) are administered at 9 AM and 9 PM; 3 times a day (TID) at 9 AM, 3 PM, and 9 PM; and 4 times a day (QID) at 9 AM, 3 PM, 9 PM, and 3 AM.

3. On 8/24/15 at 1:30 PM, Pt. #1's clinical record was reviewed. Pt. #1 was a 64 year old male, admitted on 6/5/15 with a diagnosis of dehydration. Pt. #1's medication administration record (MAR) was reviewed from Pt. #1's admission to his date of death (7/14/15). For approximately 500 medications received or refused by Pt. #1, some medications were administered late including:

- 6/13/15 - pipercillin (antibiotic), 3.375 grams (g), IVPB (intravenous piggy back), every 6 hours, start at 12:00 PM, was administered at 7:30 PM, greater than 1 hour late. No reason was documented as to why the medication was late.

- 6/18/15 - fat emulsion, 20%, 250 ml, "standard lipid hang time is 8:00 PM," was hung at 10:18 PM, more than 2 hours late. No reason was documented as to why the medication was late.

- 6/21/15 - clindamycin (antiinflammatory), 600 mg, in 5% dextrose, 50 ml IVPB, every 8 hours, was hung at 9:30 AM, more than 9 ½ hours after the previous dose (on 6/20/15 a 11:37 PM). No reason was documented as to why the medication was late.

4. Pt. #7's clinical record was reviewed on 8/26/15 at 2:00 PM. Pt. #7 was a 34 year old male, admitted on 6/27/15, with a diagnosis of angioimmunoblastic T-cell Lymphoma. Pt. #7's MAR included, Ondansetron (prevents nausea and vomiting), 8 mg, TID, was administered on 7/10/15 at 5:03 PM, over 2 hours late. No reason was documented as to why the medication was late.

5. On 8/26/15, between 1:00 PM and 3:00 PM, medication records were reviewed with the Manager of 6 SW (E #1) and an interview was conducted with E #1. E #1 stated Pt. #1 often refused medications when scheduled, but later, requested to take the medication [causing them to be late].