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.
|UNIVERSITY HOSPITAL AND MEDICAL CENTER||7201 N UNIVERSITY DR TAMARAC, FL 33321||March 13, 2014|
|VIOLATION: RN SUPERVISION OF NURSING CARE||Tag No: A0395|
|Based on interview, clinical record review and the facility policy & procedures review, it was determined the facility failed to ensure 1 of 10 sampled patients (#6) care was provided in accordance with hospital policy for critical laboratory results.
The finding includes:
Clinical record review reveals Patient #6 was admitted through the Emergency Department (ED) to the 2nd floor Intensive Care Unit (ICU) on 2/01/14, with a previous medical history that included Status post (S/P) left hip intertrochanteric fracture with a past surgical repair, Atrial Fibrillation, Anemia, Current Multiple Pressure ulcers, and Cardiac Pacemaker.
A review of the record with the ICU director, Staff ID #10, revealed a blood result positive for yeast "Candida Glavrata." Results were called by the laboratory on 2/09/14 at 4:37 AM to the ICU Nurse. The ICU nurse then called and left a telephone voice mail message to the attending Physician (ID #12) as a critical lab finding at 4:55 AM (within 30 minutes as required). The Physician (#12) responded to the critical laboratory result when making rounds on 2/09/14 at 4:40 PM (approximately 12 hours later) by ordering the anti-fungal medication Fluconazole 400 mg IV daily one time dose for treatment of this blood yeast infection.
The Infectious Disease (ID) Physician (#12) who attended Patient #6 was not available for interview during this compliant survey. Physician (ID #11) was interviewed by telephone on 3/13/14 at 12:06 PM. This interview revealed that the 12 hours period between the critical blood culture results posting and Physician order for anti-fungal medication (Fluconazole) administration "May or may not be significant as the Patient currently was receiving several other anti-biotics." Review of the clinical record indicates the following medication were currently in the patient's medication regimen: Flagyl 750 mg, Ceftriaxone 2 GM, Rocephin 2 Gm IV, Cefazolin 2 GM IV every 8 hours.
The Vice President of Regulatory Compliance (ID #1) was interviewed on 3/13/14 at 12:15 PM. During this interview she stated the Physician may have not received this telephone voice mail of the lab results and saw the critical lab results upon his Patient rounds on 2/09/14 at 4:10 PM.
The Vice President of Regulatory Compliance (ID #1) acknowledged the facility P&P for Critical values page #2 of 11 indicates in the section "C" to "D." Critical values/interpretations will be reported to a responsible physician within thirty (30) minutes, and the responsible Physician will respond within thirty (30) minutes.