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.

SAMARITAN MEDICAL CENTER 830 WASHINGTON STREET WATERTOWN, NY 13601 Dec. 12, 2017
VIOLATION: EMERGENCY SERVICES Tag No: A0093
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on document review, medical record (MR) review and interview, in 1 of 13 (Patient # 2) MRs reviewed, an adolescent patient remained in the ED for 2 days pending psychiatric placement without a daily psychiatric consult. This lack of evaluation could lead to an undetected change in the patient's condition.

Findings include:

-- Review of the hospital's policy and procedure (P&P) titled "Surge Capacity for ED Psychiatric Patients," last revised 3/2010, indicated pediatric psychiatric patients remaining in the ED longer than 24 hours pending placement will be evaluated by psychiatry on a daily basis and the evaluation will be documented in the patient's ED record.

-- Per MR review, Patient #2, (MDS) dated [DATE] for a mental health evaluation. An initial psychiatric consult was done on 5/16/17 recommending inpatient psychiatric hospitalization for further stabilization and evaluation at an adolescent child facility. Patient #2 remained in the ED pending placement and was transferred on 5/18/17. There were no psychiatric notes after the initial assessment or at the time of transfer.

-- During interview of Staff G (Quality Improvement Practitioner) on 12/12/17 at 11:45 am, he/she acknowledged the above findings.
VIOLATION: ADMINISTRATION OF DRUGS Tag No: A0405
Based on observation and interview, Staff H [emergency department (ED) registered nurse (RN)], withdrew injectable medication from a carpuject prefilled syringe cartridge into another syringe prior to medication administration. The Institute for Safe Medication Practices (ISMP), dated 8/2012, indicated this practice of transferring medications from a prefilled carpuject into another syringe increases the risk of medication errors, contamination, staff needlestick injuries.

Findings include:

-- Per observation of Staff H on 12/11/17 at 10:35 am, he/she withdrew Morphine 2 mg (milligrams) from a prefilled carpuject syringe into a separate syringe prior to medication administration.

-- During interview of Staff I (Director of Pharmacy) on 12/11/17 at 1:35 pm, carpujects are not used often, adaptors are available to staff. He/she does not recommend transferring medication from one syringe to another syringe, the carpuject is not meant to be used as a vial to withdraw medication. Staff I acknowledged the above findings at the time of interview.