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Based on a review of the clinical record of patient #1 as well as a review of facility policies and procedures, the Chief Executive Officer failed to be responsible for managing the hospital to include enforcement of facility policies and procedures.

Findings were:

During a review of the clinical record for patient #1 on 11-9-10, nursing notes document tachycardia of 120 bpm as well as shortness of breath on 5-24-09. Documentation of tachycardia (generally defined as pulse greater than 100 bpm) is present from 5-24-09 through the remainder of the patient ' s stay, but the clinical record contains no documentation of physician notification regarding the tachycardia.

During a review of the clinical record for patient #1 on 11-9-10, nursing notes document the occurrence of 6 diarrhea stools on 5-24-09, with 7 more occurrences on the 25th, 3 more occurrences on the 27th, 14 more occurrences on the 28th and 12 more occurrences on the 29th. The clinical record contains no documentation of physician notification regarding the diarrhea stools.

Facility policy V-C-4 titled Notification of Physician states, in part, " A physician should be notified of any of the following: ...Change in patient condition to include but not limited to those things listed below: (1) Signs of respiratory distress or change in character of respirations - dyspnea, ...tachycardia ...(12) Any change in patient condition that is potentially serious or life-threatening. "

The above was discussed in a meeting with the Chief Nursing Officer and the Standards Specialist on the afternoon of 11-9-10 in the Standards Office of Covenant Medical Center.

Based on a review of the clinical record of patient #1, drugs and biologicals were not administered in accordance with the orders of the practitioner or practitioners responsible for the patient's care as specified under ?482.12(c).

Findings were:

During a review of the clinical record for patient #1, physician's final discharge orders were written at 2:45 pm on 5-30-09 and nursing notes document that the patient was discharged home at 3:30 pm. The same review revealed that the medications Lactobacillus Acidophilus (due at 12:00 pm) and Flagyl 250 mg (due at 1:00 pm) were not administered, without any documentation as to the reason.

The above was discussed in a meeting with the Chief Nursing Officer and the Standards Specialist on the afternoon of 11-9-10 in the Standards Office of Covenant Medical Center.