HospitalInspections.org

Based on medical record review, hospital policy review and interview with hospital administrative nursing staff Employee identifier (EI) # 1, it was determined the hospital failed to assure all patients on sliding scale insulin had a sliding scale order signed by the physician in the medical record. This affected 3 of 4 patients on sliding scale insulin.

Hospital Policy (SOP#5.1)

Diabetes Standing Orders/Sliding Scale Protocol

Procedure:

A. The physician will initiate the Diabetes Standing Orders/Sliding Scale Protocol and will indicate the insulin sliding scale range to be used for each patient initiated on, or admitted on, sliding scale insulin therapy. The insulin sliding scale selected will be based on the type and dose of hypoglycemic therapies the patient is currently on. The scale selected will be identified by the number (1-6) at the top of the column, ie., "sliding scale # 3" or "sliding scale column 3"...

H. The physician initiating the protocol will sign, date and time the completed form. If the protocol is initiated via verbal order, the normal process for documenting and authenticating such orders will apply.

Findings include:

1. Medical record (MR) # 000112979 was admitted to the facility on 05/14/2010 with the diagnosis of Spinal Cord Lesion with Paraplegia. According to documentation on the current medication sheet, the patient was to be placed on SS # 1 (sliding scale) insulin. Review of the medical record revealed no Diabetes Standing Order/Sliding Scale Physician's Order Sheet signed by the Physician.

2. MR # 000113619 was admitted to the facility on 05/07/2010 with the diagnosis of Subdural Hematoma. According to documentation on the current medication sheet, the patient was to be placed on SS # 1 insulin. Review of the medical record revealed no Diabetes Standing Order/Sliding Scale Physician's Order Sheet signed by the Physician.



26403

3. MR # 000113585 was admitted to the facility on 05/04/2010 with the diagnosis of Cerebrovascular Accident. According to documentation on the current medication sheet, the patient was to be placed on SS # 1 insulin. Review of the medical record revealed no Diabetes Standing Order/Sliding Scale Physician's Order Sheet signed by the Physician.

An interview on 6/30/2010 at 1:20 P.M. with the nurse Manager, EI # 1, verified there was no physicians order sheet in the records.

Based on review of medical records, complaint and incident reports, as well as an interview with employee identifier (EI) # 2, pharmacy staff, it was determined that the patient did not receive ordered medication in 1 of the 9 medical records reviewed.

1. Medical Record #000113573 was admitted to the hospital 4/30/10 with diagnoses which included Parkinson's Disease, Depression, Chronic Back Pain and Urinary Incontinence.

Review of the medical record revealed the Medication Reconciliation and Drug History included Celexa 20mg two times per day (bid) and was signed by a Registered Pharmacist and the Physician on 4/30/10. Celexa, a medication for Depression was not included on the Medication Administration Record (MAR) for the dates 4/30/10 until discharge on 5/21/10. An Incident Report dated 5/23/10 stated "Celexa 20mg PO bid ordered on Medication Reconciliation Sheet 4/30/10 never transferred to MAR- patient never received medication while a patient here 4/30-5/21."

In an interview with EI # 2, the Pharmacy Director, on 6/30/10 at 12:30 P.M. the medication omission was confirmed.