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ADVENTHEALTH WESLEY CHAPEL 2600 BRUCE B DOWNS BLVD WESLEY CHAPEL, FL 33544 Feb. 13, 2013
VIOLATION: ADMINISTRATION OF DRUGS Tag No: A0405
Based on record review and staff interview it was determined the nursing staff failed to administer medications as ordered by the physician for 4 (#2, #4, #6, #9) of 10 sampled patients. This does not ensure safe medication administration and that patient care goals are met.

Findings include:

1. Patient #2's physician orders dated 12/29/12 instructed for regular insulin according to the high dose sliding scale before meals and at night. Review of the documentation of point of care blood glucose and administration of insulin revealed on 12/31/12 at 5:00 p.m. and 1/1/13 at 7:00 a.m. the patient received only 1 unit of insulin for blood glucose readings of 166 and 161. The scale calls for 2 units of insulin.

The Director of Critical Care Nursing reviewed the documentation on 2/12/13 at approximately 2:30 p.m. and confirmed the above findings.

2. Patient #4's physician ordered Zosyn 2.25 milligrams (mg) every 8 hours on 2/7/13. Review of the medication administration record (MAR) revealed the nurse documented the 2:00 p.m. dose of the medication was withheld on 2/9/13 due to the patient being in dialysis. No antibiotic was administered from 5:30 a.m. until 9:22 p.m., a total of 16 hours. Review of the Hospital Program Hemodialysis form revealed dialysis was started at 9:00 a.m. and was discontinued at 12:00 noon.

During interview on 2/13/13 at approximately 9:45 a.m., the Director of Critical Care confirmed the antibiotic should have been administered.

3. Patient #6's admission orders dated 2/10/13 revealed the physician ordered regular insulin to be administered according to the high dose sliding scale before meals and at night. Review of the point of care blood glucose documentation revealed at 7:30 a.m. it was 265. Review of the Medication Administration Record (MAR) on 2/13/13 at 9:15 a.m. revealed no insulin had been administered. According to the scale, the patient should have received 7 units.

The Director of Medical Surgical Nursing questioned the nurse who admitted she had not yet administered the insulin as required. The Director confirmed the medication was not given in a timely manner.

4. Patient #9's physician ordered Dilaudid 0.5 mg intravenously every 4 hours as needed for pain on 2/11/13. Review of the pain assessment documented on 2/11/13 at 10:00 p.m. revealed the patient reported pain of 6 on a 0-10 pain scale. Review of the MAR revealed the patient was administered 0.5 mg of Dilaudid. The patient was reassessed at 10:44 p.m. The nurse documented "no change". There was no evidence that any other pain management intervention was initiated by the nurse.

The Director of Critical Care confirmed the finding on 2/13/13 at approximately 10:30 a.m.