HospitalInspections.org

Based on record review and interview the facility failed to ensure that verbal/telephone orders were authenticated within 48 hours for 2 of 3 closed patient records that were reviewed (citing patient ID #s 27 and 28).

Findings include:

Kindred Hospital - Houston Medical Staff Rules and Regulations, revised October 25, 2007, states "All verbal orders shall be transcribed in the medical record and shall be countersigned by the practitioner in a time frame that complies with State regulations...The prescribing practitioner shall authenticate the orders as soon as possible. As soon as possible defined as the earlier of the following; the next time they provide care to the patient, or within 48 hours of when the order was given."

Review of the clinical record for patient # 27 revealed a verbal medication order written on 4/1/10 and signed by the physician on 4/5/10 (greater than 48 hours later).

Review of the clinical record for patient # 28 revealed the following telephone orders, dated and timed by the transcriber: 4/29/10 at 7 PM for admission lab tests, 5/5/10 at 2:45 PM for a consult, 5/6/10 at 11:15 for ventilator settings, 5/6/10 at 4:40 PM for multiple medication orders and arterial blood gas test, and 5/6/10 at 11:59 PM for medication and lab test. During the survey on 5/27/10, the orders remained unsigned by the physicians.

The Director of Quality and Risk Management (personnel # 53) confirmed in an interview on 5/27/10 at 2:30 PM that the physician signatures for the above telephone orders were missing.

Based on observation, interview, and record review the Hospital failed to ensure the emergency treatment room supplies were not expired and readily available per facility policies.

Findings include:

Observation 5/25/10 at 9:45 a.m. of the emergency treatment room revealed the following expired supplies in the cabinet:

-Three intravenous catheters (22 gauge) expired 09/2009
-Five intravenous catheters (20 gauge) expired 08/2009
-Sharp debridement tray expired 04/2008
-Intravenous start kit expired 01/2006
-Guaze sponges (4X4) package expired 04/2008

Further observation at this time revealed the treatment room did not stock any splinting devices in the event of a fracture.

The Clinical Nursing Officer (#50) acknowledged 5/25/10 at 10 a.m. the supplies in the emergency treatment room should not be expired.

Record review of a policy titled "Emergency Services" (no date) stated "Adequate supplies and equipment shall be available and in readiness for use."