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.

NAPLES COMMUNITY HOSPITAL 350 7TH ST N NAPLES, FL 34102 Feb. 24, 2011
VIOLATION: WRITTEN MEDICAL ODERS FOR DRUGS Tag No: A0406
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on record review and interview the facility failed to ensure that orders for drugs and biologicals are signed by a practitioner for 4 (Patients #1, #2, #3, and #4) of 5 patient records reviewed.

The findings include:

Review of the facility's Nursing Policy and Procedure Manual Section IIIG Charting and Documentation revealed a policy on physician telephone orders. The policy reads: "Telephone orders may be taken, but must be co-signed by the physician within 48 hours with time date and signature."

1. On 2/24/2010 review of clinical records revealed Patient #1 was admitted [DATE]. Physician's orders included Labor & Delivery Protocol by telephone order on 2/19/2011, Cervidil Orders by telephone order on 2/19/2011, and Oxytocin administration by telephone order on 2/19/2011. None of these orders were signed by the practitioner.

In an interview on 2/24/2011 at about 4:30 p.m., the Mother/Baby Unit Clinical Manager confirmed that the orders were not signed.

2. On 2/24/2010 review of clinical records revealed Patient #2 was admitted [DATE]. Physician's orders included admission orders for testing and routine postpartum orders for medications by telephone order on 11/8/2010, blood and urine testing by telephone order on 11/8/2010, Uncomplicated Vaginal Delivery Protocol by telephone order on 11/8/2010, and Standing Orders for Magnesium Sulfate by telephone order on 11/8/2010. None of these orders were signed by the practitioner.

In an interview on 2/24/2011 at 3:54 p.m., the Director of Patient Advocacy and Regulatory Compliance said that he was unable to determine that the orders had been validated.

3. On 2/24/2010 review of clinical records revealed Patient #3 was admitted [DATE]. Physician's orders included admission orders for lab tests by telephone order on 11/25/2010, orders for magnesium sulfate administration, Percocet administration, and uric acid testing by telephone order on 11/25/2010, and Standing Orders for Magnesium Sulfate by telephone order on 11/25/2010. None of these orders were signed by the practitioner.

In an interview on 2/24/2011 at 3:14 p.m., Mother/Baby Unit Clinical Manager confirmed that the orders were not signed.

4. On 2/24/2010 review of clinical records revealed Patient #4 was admitted [DATE]. Physician's orders included Standing Orders for Magnesium Sulfate by telephone order on 12/3/2010 and Profile I tests by telephone order on 12/4/2010. None of these orders were signed by the practitioner.

In an interview on 2/24/2011 at 3:51 p.m., the Corporate Counsel confirmed that the orders were not signed.