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This deficient practice remains uncorrected. For addition examples please refer to the statement of deficiencies (SOD) dated 04/14/11.

Based on facility policy review, record review and interview, the facility failed to obtain complete orders to restraint two (#2, #3) of three patient records reviewed for restraint orders. The facility census was 184.

Findings included:

1. Record review of the facility's policy titled "CH Use of Restraints", revised 12/8/10, showed the following direction: the physician's verbal or written order must indicate the reason for restraint, the type of restraint and the time limit for restraining the patient.

2. Record review of Patient #2's medical chart showed a restraint order dated 06/15/11 at 7:15 AM.
-The order did not contain the behaviors which made a restraint necessary;
-The type of restraint device to be used;
-The criteria for release of the restraint.

3. Record review of Patient #3's medical chart showed a restraint order dated 06/15/11 at 6:15 AM.
-The order did not contain the type of restraint device to be used.

During an interview on 06/15/11 at 10:50 AM, Staff C, Intensive Care Unit (ICU) nurse stated that the order of 06/15/11 at 7:15 AM was not complete and the order of 06/15/11 at 6:15 AM did not contain whether wrist or leg restraints were to be applied.




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This deficient practice remains uncorrected. For addition examples please refer to the statement of deficiencies (SOD) dated 04/14/11.

Based on observation, interview and facility policy review, the facility staff failed to follow the facility policy for dating and labeling intravenous (IV) tubing for three (#1,#10, #11) of three patients. This potentially places all patients with IV tubing at risk for infection. The facility census was 184.

Findings included:

1. Record review of the facility policy titled "CH IV Infusion Pumps, Tubings, and Filters(Nursing)", dated 02/13/08, showed the following staff direction:
-All tubing shall be labeled when it is changed and documented online under the intervention: IV monitor

2. Observation on 06/14/11 at 2:50 PM in the Mother and Baby unit in Patient #1's room showed a bag of Intravenous Fluid (Pitocin) [a medication which is used to start or improve uterine contractions] infusing into the patient. The tubing which carried the fluid from the bag into the patient did not have a label (a paper tag which is placed on the tubing with an area to date when the tubing was first attached to the bag and an area to date when the tubing should be changed). The tubing did not have the identifying label.

During an interview on 06/14/11 at 2:55 PM, Staff A, Registered Nurse (RN), stated that the bag of Pitocin had been placed in Labor and Delivery and then the patient had been transferred to his/her unit (Mother and Baby) with the bag and tubing. When the patient arrived on the unit, the tubing did not have a label identifying when the tubing was first attached to the bag and did not have a date when the tubing was to be changed.

3. Observation on 06/14/11 at 3:15 PM in the Labor and Delivery Unit in Patient #10's room showed three bags of IV solutions infusing into the patient. The tubings had no label identifying when the tubing had been first attached to the bag and did not have a date when the tubing should be changed.

4. Observation on 06/14/11 at 3:25 PM in the Labor and Delivery Unit in Patient #11's room showed no labeling of the tubing identifying the date when the tubing had first been placed and had no date to show when the tubing should be changed.

During an interview on 06/14/11 at 3:32 PM Staff B, RN, stated that he/she placed an antibiotic in the room of patient #10 but the tubing was already there. He/she also stated that tubing was supposed to be labeled with the date the tubing had been placed and with the date the tubing should be changed.







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This deficient practice remains uncorrected. For additional examples please refer to the Statement of Deficiency (SOD) dated 04/14/11.

Based on observation, interview and policy review the facility failed to ensure staff followed the facility policy to give medications in a timely manner for one (#5) of three patients observed during medication pass. This failure occurred on the 4th floor nursing unit when four of 15 medications observed were give 90 minutes after the ordered time. The facility census was 184

Findings included:.

1. Record review of the policy titled "CH Standard Medication Administration and Reconciliation Times (Nursing)", revised 01/23/11, showed the following:
-Medications are administered to patients thirty (30) minutes either side of scheduled time, which may vary in accordance with meal times on each unit.

2. Observation on 06/15/11 at 10:30 AM, showed Staff F, Registered Nurse (RN), administered three medications by mouth and attempted to give one eye drop medication (refused) to Patient #5 on the 4 East Unit.

Record review showed these medications were ordered by the physician to be administered to Patient #5 at 9:00 AM.

During an interview on 06/15/11 at 10:30 AM, Staff F, RN, stated that he/she was running late and just now able to administer these medications. Staff F, RN, stated that the medications were administered after the ordered time.