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Based on observation, interview and record review, the facility failed to ensure facility's nursing and pharmacy staff communicated with patients' attending physicians regarding clarification of physicians' orders and failed to administer medication as prescribed by the physician in 2 of 8 sampled patients. Patient #s 2 and 3

Findings:

Patient # 2
On 12/02/2015 at 8:45 a.m. Patient #2 was observed in the intensive care unit at hospital campus (B). The patient was alert and oriented to person place and time. The patient had a right triple lumen subclavian catheter in place and a right arm fistula which she used for hemodialysis treatment.

Interview on 12/02/2015 at 8:48 a.m. with Registered Nurse (A) revealed, the patient receives hemodialysis treatment three times weekly on Mondays, Wednesdays and Fridays on the unit from a contracted hemodialysis provider.

Review of the Patient's clinical record (demographic data) revealed the patient was admitted to the facility with diagnosis of hypotensive episode, end stage renal disease and legally blind.
Review on 12/02/2015 of Patient #2's clinical record revealed the following Physician's Orders:
Order dated 11/25/2015: " Midodrine 10 mg po tid, Midodrine 10 mg po bid I tab before HD and I tab after first hour of HD on Tue, Thur and Sat."
"Fludrocortisone Acetate 0.2 mg on hemodialysis days TT SAT Q p.m., Fludrocortisone acetate 0.1 mg on non- hemodialysis day MWF."

Review of the Patient's Medication Administration Records dated 11/25/2015 - 12/02/2015 revealed no indication that Midodrine was administered to the patient as prescribed by the patient's nephrologist.
Review of the patient's Medication Administration Record revealed documentation which indicated Fludrocortisone acetate 0.2 mg , Fludrocortisone acetate 0.1 mg were administered in the reverse, because the patient received hemodialysis on Mondays, Wednesdays and Fridays.

Review of the Medication Administration Records revealed documentation which indicated that the physician's order for Midodrine was transcribed to be administered whenever necessary and not as a scheduled medication. The transcribed order on the Medication Administration Records read as follows: " Midodrine HCL 10 mg po with dialysis as needed. I tab before HD and one tab after first hour of HD Tue- Thur - Sat. "

Interview with the Facility's Chief Nursing Officer on 12/02/2015 at 9:55 a.m. revealed she had called the facility's pharmacist to clarify the order ( after the Surveyor identified the error) and was told that Midodrine order was entered into the pharmaceutical system using the wrong code.

Interview on 12/02/2015 at 10:35 a.m. with Patient #2's attending nephrologist, she stated that the medication Midodrine was to be administered as a scheduled medication and that she wanted the patient to be given the medication of Midodrine and Fludrocortisone on hemodialysis days Mondays, Wednesdays and Fridays.

Patient #3
On 12/02/2015 at 8:32 a.m. Patient #3 was observed in the intensive Care Unit at hospital campus (B).
Review of Patient #3's clinical record revealed a physician's order dated 11/24/2015 for sliding scale Novolin insulin of 5 units for blood glucose level between 151 - 200.

Review of the record (Medication Administration Record) revealed documentation which indicated that the patient's recorded blood glucose level on 11/27/2015 at 6:00 p.m. was 161 mg/dl.
Review of the patient's clinical record, (Medication Administration Record and Nurses ' Notes ) dated 11/27/2015 revealed no indication that the patient was administered Novolin Insulin 5 units for blood glucose of 161 mg/ dl.

Interview on 12/02/2015 at 3:30 p.m. with the Facility's Chief Nursing Officer revealed she had checked the record of the medication dispensing system (Pyxis) to determine if Insulin was dispensed to be administered to Patient #3 but there was no record of Insulin been dispensed or administered.