The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

BAXTER REGIONAL MEDICAL CENTER 624 HOSPITAL DRIVE MOUNTAIN HOME, AR 72653 March 25, 2011
VIOLATION: ADMINISTRATION OF DRUGS Tag No: A0405
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of policy and procedures, clinical records and interview, it was determined the facility failed to assure 3 ( #11, #13 and #19) of 30 (#1-#30) patients received medication as ordered by the physician. The failure to administer medications or notify the patient placed three patients at risk for harm and had the potential to affect 128 inpatients on census on 03/22/11. The findings are:

A. On 03/24/11 at 1510, Registered Nurse (RN) #2 provided the facility policy and procedure "Nursing Service 7.15: Medication Administration Guidelines" for review by Surveyor. The policy stated "If for some reason a medication is not given, the nurse will note the omission on the eMAR (electronic Medication Administration Record), document reason and electronically sign the entry. Physicians will be notified of the omission as appropriate."
B. Review of the clinical record for Patient #11 on 03/24/11 revealed a physician's order dated 03/17/11 for Metoprolol (Lopressor) 25 milligrams, by mouth three times per day. Review of the eMAR Summary with RN #1 on 03/24/11 revealed an entry for the Lopressor on 03/17/11 at 0800 that stated "Not Done Not Appropriate at this time @0800." The clinical record did not include documentation of a physician order to hold the Lopressor or that the physician was notified the medication was not administered. The findings were confirmed by RN #1 on 03/24/11 at 1430.
C. Review of the clinical record for Patient #13 on 03/24/11 at 1550 revealed a physician's order dated 03/21/11 for Isosorbide dinitrate (Isordil) 40 milligrams, two tablets P.O. (by mouth) TID (three times per day). Review of the eMAR Summary with RN #1 on 03/24/11 revealed the Isordil was not administered as ordered from 03/22/11 to 03/24/11 eight of nine times. The clinical record did not include documentation of a physician order to hold the Isordil or that the physician was notified the medication was not administered. The findings were confirmed by RN #1 on 03/24/11 at 1550 and she stated "They are supposed to notify the physician when a medication is held."
D. Review of the clinical record for Patient #19 on 03/25/11 at 0900 revealed a physician's order dated 03/20/11 for bumetanide two milligrams, two tabs P.O. daily. Review of the eMAR Summary with RN #1 on 03/25/11 revealed the bumetanide was not administered at 0900, and the entry had the statement "Not Done patient hypotensive, will monitor @0900." A physician order was noted on the eMAR Summary 03/21/11 for lisinopril 10 milligrams, one tablet P.O. daily and was noted 03/23/11 at 0900 as "Not Done; patient hypotensive, will monitor @0900." An order for Lopressor 100 milligrams, two tablets P.O. twice per day as noted on 03/21/11. The medication was documented as "Not done, patient hypotensive, will monitor." The clinical record did not include documentation of a physician order to hold the bumetanide, isordil, lisinopril or that the physician was notified of the patient's hypotension. The patient was discharged [DATE].
VIOLATION: CONTENT OF RECORD - OTHER INFORMATION Tag No: A0467
Based on clinical record review and staff interview, it was determined the nursing staff did not document patients' received a bath, shower or oral care for five (#1, #2, #3, #4 and #6) of five active patients and five of five (#8-#12) discharged patients. The failed practice prevented the continuity of patient care. The failed practice affected all eight patients on census and all patients admitted to the Psychiatric Unit. The findings were:

A. Review of the " Patient Care Plan Implementation Phase " for Patient #1-#4, #6 and #8-#12 revealed that baths and showers were not recorded and oral care on the day shift was not recorded.
B. Interview on 03/15/11 at 1450, the interim Nurse Leader was questioned regarding the documentation for showers, etc, she stated in the two and half years she had been here bath/showers have not been recorded. The interim Nurse Leader stated they write down when a patient has a shower on the Shower Log but information did not get put in the clinical record. Review of two most current Shower Log sheets revealed it had a column for the pre-printed room numbers, a column for the patient ' s name, a column for date of last shower, a column for shift (7P or 7A) and a column for signature. There was no consistency of recording showers on the tool which was confirmed by the interim Nurse Leader.
VIOLATION: PROGRAM SCOPE, PROGRAM DATA Tag No: A0273
Based on staff interview, it was determined the hospital did not assure the Psychiatric Unit (managed by a contracted company) submitted quality indicators and the monitoring outcomes to the hospital wide Quality Assessment Process Improvement Committee to ensure the delivery of care to the psychiatric patient. The failed practice had the potential to affect all eight patients on census and all patients admitted to the Unit. The findings were:

Interview on 03/17/11 at 1400, the Nurse Leader of 3South confirmed the contracted company's Quality Assessment/Process Improvement activities were not reported to the hospital wide Quality Assessment/Process Improvement Committee.
VIOLATION: PATIENT SAFETY Tag No: A0286
Based on staff interview, it was determined the hospital did not assure the Psychiatric Unit (managed by a contracted company) submitted quality indicators and the monitoring outcomes to the hospital wide Quality Assessment Process Improvement Committee to ensure the delivery of care to the psychiatric patient. The failed practice had the potential to affect all eight patients on census and all patients admitted to the Unit. The findings were:

Interview on 03/17/11 at 1400, the Nurse Leader of 3South confirmed the contracted company's Quality Assessment/Process Improvement activities were not reported to the hospital wide Quality Assessment/Process Improvement Committee.