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Based on record review and interview, the hospital failed to administer medications as ordered by the physician and applicable standards of practice as evidenced by failing to administer "Now" doses of medication within one hour per policy for 3 of 3 sampled patients reviewed for "Now" orders in a total sample of 30. (Patient #3, 4, 14)
Findings:

Review of the hospital policy titled, Orders: Stat, revealed in part that "Stat" and "Now" orders are synonymous. These medication orders should take no more than one hour to administer.

Patient #3
Review of the record revealed a physician order dated 09/20/20 at 7:10 p.m. to administer Tegretol 100mg by mouth now. Review of the MAR revealed the medication was not administered until 11:00 p.m. (almost 4 hours later).

Further review of the record revealed a physician order dated 09/18/20 at 5:45 p.m. to administer Geodon 40mg by mouth now. Review of the MAR revealed the medication was not administered until 9:00 p.m. (3 hours and 45 minutes later) .

Patient #4
Review of the record revealed a physician order dated 09/28/20 at 1:20 p.m for Potassium 40meq IV times one dose now due to the patient's low potassium level. Review of the MAR revealed the medication was not administered until 4:00 p.m. (2 hours and 40 minutes later)

Patient #14
Review of the record revealed a physician order dated 09/25/20 at 12:40 p.m. for Potassium 40meq per tube times one dose now for a low potassium level. Review of the MAR revealed the medication was not administered until 3:30 p.m. (almost 3 hours later).

On 09/29/20 at 2:40 p.m., interview with S1DON confirmed that the hospital policy is to administer medications ordered for "Now" within one hour. S1DON further confirmed that the above patients did not receive their "Now" medications within the one hour time frame.

Based on record review and interview, the hospital failed to ensure all medication orders (except in emergency situations) were reviewed by a pharmacist before the first dose was dispensed (review for therapeutic appropriateness, duplication of a medication regimen, appropriateness of the drug and route, appropriateness of the dose and frequency, possible medication interactions, patient allergies and sensitivities, variations in criteria for use, and other contraindications).
Findings:

Review of the Louisiana Administrative Code, Title 46 Professional and Occupational Standards, Part LIII Pharmacist, Chapter 15 Hospital Pharmacy, Section: 1511: Prescription Drug Orders, Item A. The pharmacist shall review the practitioner's medical order prior to dispensing the initial dose of medication, except in cases of emergency.

Review of the hospital policy titled, Drug Therapy Monitoring, Policy Number 10-14.13.0, dated January 2004 revealed in part: With the exception of emergency orders when time does not permit, a pharmacist shall review the patient's drug therapy (current drug regimen) prior to dispensing new orders for drugs to the patient.

Review of the hospitals Override Transaction Profile report dated 07/01/20 - 09/28/20 revealed 97 medications were on the report, indicating that they had been overriden and removed from the automated medication dispensing system prior to a pharmacist review. Further review of the medications revealed they were not emergency medications.

Interview on 09/29/2020 at 11:00 a.m. with S1DON confirmed that she was aware of the issue that nurses are overriding the automated medication dispensing system in order to administer new medications prior to a first dose review by a pharmacist. She further stated that this had been ongoing and was a problem the last time the hospital was surveyed.

20310

Based on observation and interview, the hospital failed to employ methods for preventing transmission of infections within the hospital by failing to maintain a sanitary environment in empty patient rooms which were ready for new admissions.
Findings:

On 09/28/20 at 8:45 a.m., during the facility tour, observation of empty patient room a revealed a freshly made bed and several pieces of equipment covered with plastic bags. Further observation revealed the overbed table had dust and debris covering the bottom surface over the wheels, and the pull out tray had a large dried sticky brown spill on its surface. The top drawer of the bedside table had crumbs and debris on the inside surfaces. A metal table with multiple areas of peeling paint and rusted surface areas was sitting in a corner near the bathroom.

On 09/28/20 at 9:00 a.m., observation of empty patient room b revealed a freshly made bed and several pieces of equipment covered with plastic bags. Further observations in the room revealed the bed frame had a build up of dust, debris and hairs. A dried red substance was observed on the bed frame. Further observations revealed the bathroom door handle had a dried red substance on it.

An interview with S2HSK on 09/28/20 at 9:10 a.m. confirmed that she had cleaned room a and b earlier and they were ready for a new admission.