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Based on medical record reviewed staff interviews, The hospital failed to ensure that 1 of 10 patients had received a physician ordered procedure completed in a timely manner. Failure to completed procedures placed this patient and all patients at risk for harm or worsening on their conditions.

Findings include;

1. The medical record of 1 patient was reviewed on August 18, 2011. The patient had been admitted to the hospital for care and treatment of a bowel obstruction. Staff were unable to insert a nasogastric tube (NGT) to the patient ' s stomach. The patient was taken to the interventional radiology department where a NGT was inserted with the assistance of imaging.

The patient improved and the NGT was removed the following day. During the early hours of the next day, the patient started vomiting. The physician was notified and the patient was give antiemetic medication which nursing documentation noted was " moderately " successful in relieving the vomiting. At 10:00 AM the physician wrote an order for a NGT to be placed by radiology.

The patient continued to vomit with little relief. In an interview with the staff nurse caring for the patient, a nursing director stated s/he was told that the nurse called the radiology 4 times to find out when the patient was to be seen.

There was no documentation in the medical record that nurse had notified the physician of the delay or that the patient continued to vomit. There was no documentation in the medical record that the nursing care plan had been modified based on reassessment and a change in condition.

The patient was taken to the radiology department at around 4:00 PM and the radiology physician documentation noted a NGT was inserted at about 5:00 PM., 7 hours after the procedure was ordered. The patient returned to the room and the large amount of fluid loss through the NGT required intravenous fluids for replacement.

The following day a progress note written by the physician stated the patient ' s acute renal failure had worsened due to the inadequate administration of intravenous fluids to compensate for the large losses of fluid from the NGT and vomiting. The patient ' s urine output had also diminished, the patient ' s blood pressure was low, and their heart rate had increased which are symptoms of inadequate fluid replacement.

Over the next few days the patient's condition deteriorated. The patient asked to be on comfort care due to her/his condition. This care was provided and the patient died within a few days.

2. A director of the interventional radiology department (IRD) was interviewed on August 19, 2011. The director stated the IRD was very busy that day with STAT (immediate) and ASAP (as soon as possible) procedure orders from the ED.

The director stated that procedures were performed according to the department priority system. She stated that Emergency Emergency Department (ED) patients were considered the first priority, then inpatients, then outpatients. When asked why were ED patients were considered a first priority, she stated that it was assumed the patients had urgent needs. When asked why an X-ray of a foot was a higher priority that a patient who had been vomiting for approximately a total of 14 hours, she could not answer the question.

3. A director of patient services was interviewed on August 19, 2011. She stated the procedure had been ordered as a routine test. She stated if this procedure had been ordered at a higher priority level, it may have been completed prior to a routine priority.

The director stated she had interviewed the staff nurse taking care of the patient that day. She stated the staff nurse had told her she had telephoned the IRD 4 times to find out when the patient was to have the procedure completed. The director stated the staff nurse had not notified the patient's physician that the procedure had been delayed or that the patient had continued to vomit.