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.

NORTH METRO MEDICAL CENTER 1400 BRADEN STREET JACKSONVILLE, AR 72076 Aug. 17, 2015
VIOLATION: PATIENT RIGHTS: NOTICE OF RIGHTS Tag No: A0117
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on clinical record review and interview, it was determined the Facility failed to ensure an Important Message from Medicare was provided within two days prior to discharge for one of one(#1) Medicare patients who had been discharged ; and failed to ensure an Important Message from Medicare was signed and dated within two days of admission for four of four (#2, #3, #4 and #5) Medicare patient clinical records reviewed. The failed practice created the potential for patients to be uninformed of their rights and could affect any Medicare patient admitted to the Facility. Findings follow:

A. Review of clinical records revealed the following:
1) Patient #1 - admitted [DATE] through 08/13/15-did not have an Important Message from Medicare within two days prior to discharge.
2) Patient #2 - admitted [DATE]-had not been discharged as of the time of clinical record review. The Important Message from Medicare had not been signed or dated.
3) Patient #3 - admitted [DATE]-had not been discharged as of the time of clinical record review. The Important Message from Medicare was not dated.
4) Patient #4 - admitted [DATE]-had not been discharged as of the time of clinical record review. The Important Message from Medicare had not been signed or dated.
5) Patient #5 - admitted [DATE]-had not been discharged as of the time of clinical record review. The Important Message from Medicare had not been signed or dated.

B. During an interview on 08/14/15 at 1515, the Chief Nursing Officer confirmed the findings for the Important Messages from Medicare.
VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING Tag No: A0144
Based on observation, review of policies and procedures and interview, it was determined the Facility failed to ensure patient safety in that medications were removed from their packaging and placed in open medication cups and stored prior to administration. The individual medications were not labeled and could not be verified prior to administration as per policy. The practice of opening individual pills or powder and placing them in medication cups in advance of scheduled dosage administration did not assure the rights of patients to receive care that was provided in a safe manner and according to policy. The findings were:

On 08/10/15 at 1040, observation on tour revealed the medication cart identified by Licensed Practical Nurse (LPN) #1 as the cart she was working from revealed seven ( Room 122 A, 123 A, 123 B, 124 B, 125 A, 125 B and 127 B) of nine (122 A-127 B) patients had medication cups in the medication cart with pills and/or powder that were not in individual packaging. The pills and/or powder were loose in the medication cup and identified by room number only. The findings were verified by the Chief Nursing Officer at 1040 on 08/10/15.

On 08/10/15 at 1045, observation on tour revealed the medication cart identified by Registered Nurse (RN) #3 as the cart she was working from revealed two ( Room 118 A, three pills, 118 B, two pills)of nine (118 A-121 B) patients had medication cups in the medication cart with pills and/or powder that were not in individual packaging. The pills were loose in the medication cup and identified by room number only. The findings were verified by the Chief Nursing Officer at 1045 on 08/10/15.

Review of the policy "Administration of Medication" revealed "The patient will be properly identified according to the five rights of medication administration: right patient, right medication, right dosage, right route and right time." The procedure listed "Check name of medication with name on MAR (Medication Administration Record). Obtain, draw up or pour correct dose following the three checks: Check when getting medication out of drawer or narcotic cabinet; check when selecting or preparing to pour/draw up and check before discarding the packet or placing the container back in storage. Check that the medication is stable based on visual exam and that the medication has not expired. Recheck medications, MAR and dosage. Take MAR and medications to patient's room, check the name and medical record number (MRX) on both the armband and MAR, administer medication after explanation." Preparing the medication dosage prior to administration, by removal from labeled packaging and placing them in a medication cup, did not assure the medication could be identified or verified with the medication administration record as required by policy.

The Chief Nursing Officer stated at the time of observation the staff were not trained to prepare medication as observed 08/10/15 1045.