HospitalInspections.org

Amended Statement of Deficiencies

Based on medical record review, observation, and interview, the facility nursing staff failed to ensure clarification for orders for medications for 3 patients (#3, #4, and #5) of five medical records reviewed; and failed to ensure medications for the management of pain were administered as requested for one patient (#5) of five medical records reviewed.

The findings included:


Patient #3 was admitted to the facility on March 27, 2012, with diagnoses to include Acute Renal Insufficiency, Urinary Tract Infection, Atrial Fibrillation, and Chronic Right Foot Pain secondary to Fasciitis.

Medical record review of the Physician's orders revealed the following: March 27, 2012, at 8:06 p.m. - Percocet (narcotic pain medication) 10/325 mg (10 milligrams oxycodone/325 milligrams acetaminophen) po (by mouth) tid (three times daily) PRN (as needed) for pain and Xanax (controlled medication for anxiety) 2 mg po bid (twice daily) PRN anxiety; and March 27, 2012, at 9:00 p.m. - Morphine (narcotic pain medication) 2 mg IV (intravenous) every 4 hours a PRN.

Medical record review of the Medication Administration Record (MAR) revealed the patient received the following PRN medications:, March 27, 2012, at 9:22 p.m. the patient received Morphine 2 mg IV and Xanax 2 mg po; March 28, 2012, at 9:01 a.m., 2:48 p.m., and 9:21 p.m. the patient received Percocet 10/325 mg po, and Xanax 2 mg po at 9:25 a.m. and 9:28 p.m.; and March 29, 2012, at 10:05 a.m. and 4:58 p.m., the patient received Percocet 10/325 mg po.

Patient #4 was admitted to the facility on March 23, 2012, with diagnoses to include Abdominal Distention with Intractable Vomiting, Possible Obstruction, Anxiety with Panic Attacks, and Small Pleural Effusion.

Medical record review of the Physician's orders revealed the following: March 23, 2012, at 3:30 p.m. - Zofran (medication for nausea) 4 -8 mg IV every 6 hours PRN, and Phenergan (medication for nausea) 12.5 mg IV every 6 hours PRN; March 23, 2012, at 6:30 p.m. - Minimize narcotics as much as possible; March 23, 2012, at 11:25 p.m. - D/C (discontinue) Phenergan 12.5 mg IV PRN, Phenergan 6.25 mg IV every 4 hours PRN; March 24, 2012, at 10:40 a.m. - Dilaudid (narcotic pain medication) 0.5 mg and Phenergan 6.25 mg IV every 4 hours PRN; and March 25, 2012, at 5:00 p.m. - Zofran 4 mg sublingual every 8 hours PRN.

Medical record review of the MAR revealed the patient received the following medications: March 24, 2012 -Phenergan 12.5 mg IV at 11:02 p.m.; March 24, 2012 - Dilaudid 0.5 mg IV at 3:22 p.m.; March 25, 2012 - Dilaudid 0.5 mg IV at 12:30 a.m., Phenergan 6.5 mg IV at 7:46 p.m., Zofran 4 mg IV and Dilaudid 0.5 mg IV at 9:59 p.m.; and March 26, 2012 - Zofran 4 mg IV.

Patient #5 was admitted to the facility on May 16, 2012, with diagnoses to include Polynephritis and Intractable Vomiting.

Medical record review of the Physician's orders revealed the following: May 16, 2012, at 8:00 p.m. - Dilaudid 1-2 mg IV every 4 hours PRN pain, and Phenergan 12.5 mg IV every 6 hours PRN nausea and vomiting; May 18, 2012, at 11:00 p.m. -Zofran 4 mg IV every 6 hours PRN nausea; May 21, 2012, at 9:00 p.m. - Methadone (controlled pain medication) 5 mg po (by mouth) tid (routinely); and May 22, 2012, at 6:30 a.m. - Methadone 5 mg po every 6 hours PRN pain.

Medical record review of the MAR revealed the patient received the following medications: May 18, 2012 -Dilaudid 2 mg IV at 9:18 a.m., 1:35 p.m., 5:53 p.m., and 9:53 p.m., and Zofran 4 mg IV at 10:05 p.m.; May 19, 2012 - Dilaudid 2 mg IV at 1:57 a.m., 6:06 a.m., 2:52 p.m., 6:34 p.m., and 10:36 p.m., and Zofran 4 mg IV at 10:36 p.m.; May 20, 2012 - Dilaudid2 mg IV at 4:29 a.m., 8:42 a.m., 1:01 p.m., 5:07 p.m., 9:22 p.m., and Zofran 4 mg IV at 9:22 p.m.; and May 21, 2012 - Phenergan 12.5 mg IV at 1:24 a.m., Dilaudid 2 mg IV at 10:10 a.m., 2:12 p.m., and 6:54 p.m., and Methadone 5 mg po at 9:00 p.m. (routine order).

Interview at the 200 hall nursing station with the Unit Manager and the Registered Nurse in Charge on May 22, 2012, at 10:45 a.m., confirmed the nurses were to use the lowest dose and longest time between medication administrations when available; the lowest dose and longest time between doses was not utilized when two doses and time frames were available; there was no documentation present to indicate rational for using the higher dose and closest time frame of two doses available; and the physician had not been notified to obtain clarification when two PRN medications of the same classification were available.

Interview with the Chief Nursing Officer in the conference room on May 22, 2012, at 4:00 p.m., confirmed the nurses were to use the lowest dose and longest time between medication administrations when available; the lowest dose and longest time between doses was not utilized when two doses and time frames were available; there was no documentation present to indicate rational for using the higher dose and closest time frame of two doses available; and the physician had not been notified to obtain clarification when two PRN medications of the same classification were available.

Patient #5 was admitted to the facility on May 16, 2012, with diagnoses to include Polynephritis, and Intractable Vomiting.

Medical record review of the Physician's orders revealed the following: May 16, 2012, at 8:00 p.m. - Dilaudid 1-2 mg IV every 4 hours PRN pain. Continued review revealed May 21, 2012, at 9:00 p.m. - Methadone (controlled pain medication) 5 mg po (by mouth) tid (routinely); and May 22, 2012, at 6:30 a.m. - Methadone 5 mg po every 6 hours PRN pain.

Medical record review of the MAR revealed the patient received the following medications: May 18, 2012 -Dilaudid 2 mg IV at 9:18 a.m., 1:35 p.m., 5:53 p.m., and 9:53 p.m.; May 19, 2012 - Dilaudid 2 mg IV at 1:57 a.m., 6:06 a.m., 2:52 p.m., 6:34 p.m., and 10:36 p.m.; May 20, 2012 - Dilaudid2 mg IV at 4:29 a.m., 8:42 a.m., 1:01 p.m., 5:07 p.m., 9:22 p.m.; and May 21, 2012 - Dilaudid 2 mg IV at 10:10 a.m., 2:12 p.m., and 6:54 p.m., and Methadone 5 mg po at 9:00 p.m. (routine order).

Observation and interview on May 22, 2012, at 10:50 a.m., with patient #5, in the room of patient #5, revealed the patient reported being in pain, requesting pain medications, and not receiving pain medications as requested over the past 10 hours.

MAR review revealed the patient's last dose of pain medication was administered on May 21, 2012, at 9:00 p.m., almost 15 hours since last dose of medication for pain.

Interview at the 200 hall nursing station with the Unit Manager and the Registered Nurse in Charge on May 22, 2012, at 10:55 a.m., confirmed the physician had been notified of the patient's complaints of pain and on May 22, 2012, at 6:00 a.m., ordered the patient's pain medication to be given every 6 hours as needed. Continued interview confirmed the medication was to be given at 6:00 a.m. and was not.

Interview with the Chief Nursing Officer in the conference room on May 22, 2012, at 4:00 p.m., confirmed the nursing staff failed to provide patient #5 the requested and ordered medication for pain relief.