HospitalInspections.org

Based on review of facility policies, record review, and staff interview Hill Country Specialty Hospital New Braunfels failed to follow its own policy to provide contract employees with orientation to the facility.

The findings include:
a. Review of facility policy number I-B.2.20, Orientation and Training on 5/26/11 at 10:10 a.m., it states "It is the policy of the hospital to provide orientation programs for new employees and to conduct or support training programs as deemed appropriate."
b. Review of the personnel file of contract staff, S5, on 5/26/11 at 10:00am in the conference room, there was no documentation found that the nurse had been provided orientation to the facility or facility policy and procedures prior to caring for patients in the facility.
c. During an interview with facility personnel, S4, on 5/26/11 at 10:15 a.m. she said the facility is to provide and document orientation to the contract employees. She provided an Agency Orientation Checklist for RN/LVN. She acknowledged there was no Agency Orientation Checklist in the personnel file of agency staff S5, and could not produce any evidence of one being completed for agency employee S5.

Based on chart review and staff interview, Hill Country Specialty Hospital New Braunfels failed to administer drugs in accordance with physician orders as required by federal and state laws and regulations.

1. Review of the medical record of patient, P1, it was noted by the nurse caring for the patient on 2/13/11 at 1630 p.m., there was no NS(normal saline) in facility to give the patient a normal saline bolus that was ordered by the physician as a NOW order at 1610 p.m. for hypotension. The charge nurse had to call the pharmacy tech back to the hospital to obtain the normal saline from the pharmacy. The normal saline bolus was not given to the patient until 1810 p.m., a delay of 2(two) hours. This placed the patient with hypotension at risk for continued deterioration in medical status. There was no documentation in the patient medical record the physician was notified of this delay in his orders.
2. During an interview with facility staff member, S1, at the entrance conference on 5/25/11 at 10:00 a.m. the facility administrator was not aware this incident had occured in the facility.

Based on medical record review Hill Country Specialty Hospital New Braunfels failed to furnish services in accordance with a written plan of treatment.

The findings include:
a. Review of the medical record for patient, P1, on 5/25/11 at 11:40 a.m. in the facility conference room revealed the written plan of treatment did not include the orders of the physician to get the patient out of bed 3(three) times per day with meals. When the patient was unable to perform prescribed plan of treatment there was no indication the plan of treatment was revised and reviewed with the medical practitioner. When the physician ordered the patient to be out of bed three times per day on 2/7/11, 2/8/11, and on 2/10/11 the treatment plan was still only sitting the patient on the edge of the bed and not incorporating the physician orders of getting the patient out of bed into the plan of treatment. There was no indication in the chart the physician was notified of the lack of progress by the patient as indicated by the physician order on 2/10/11 to call him each time the patient does not get out of bed.
b. These findings were reviewed with facility staff member, S4, on 5/25/11 at 3:05 p.m. and no evidence was presented to show compliance.