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Based on interviews and documentation review, it was determined the Hospital failed to identify all opportunities for improvement during a review of an incident/complaint involving the Patient.

Findings include:

1.) Interview with the Risk Manager and review of the Hospital's investigation regarding the Patient's care indicated the investigation identified nursing documentation issue with Nurse #4. The corrective action revealed the nurse was counseled by her manager. Random review will be performed for compliance.

2.) The investigation did not evidence the Patient continued to be in severe pain despite interventions that included narcotics and there was no follow up medical care and/or evaluation despite ongoing nursing assessment which documented the Patient's pain at 9-10.

3.) There was no re-education provided regarding the alleged injury and IV safety after the Hospital became aware of the Patient's complaint on 6/16/10.

4.) The investigation did not evidence the saline flushes were not documented in the Patient's record as required per Hospital policy.

Based on documentation review of one of one applicable medical record it was determined Hospital Medical Staff failed to continue to assess and/or document assessments of the Patient's right arm and the Patient's response to pain intervention that were determined to be ineffective in relieving the Patient's right arm pain.

Findings included:

Review of medication administration records at 11:51 and 11:52 AM indicated the Patient complained of 10/10 pain in her right arm and was medicated with 2 milligrams (mg) of Dilaudid (narcotic pain reliever) for the pain.

The Attending Physician's medical progress note at 12:30 PM indicated the Attending Physician contacted a vascular surgeon who stated that because the Patient's capillary refill (the rate at which blood refills empty capillaries) in the right extremity was fine, the Patient could be monitored conservatively. However, the actual capillary refill assessment was not found in the Patient's record. The Attending Physician said he called a radiologist in the Hospital and talked with that physician about performing a MRI, however, MRI's were not performed on the weekends.

Documentation at 12:45 PM the Patient continued to complain of 9/10 pain. The Attending Physician was notified and review of medication administration records indicated at 1:29 PM the Patient was administered an additional 2 mg of oral Dilaudid.

At 2:30 PM the Patient's pain was reassessed and was noted to be rated 9/10.

Nursing documentation and medication administration records dated 5/23/10 indicated at 3:29 PM the Patient's pain level was 10/10 and was medicated with 2 mg of Dilaudid.

Nursing documentation indicated at 4:20 PM indicated the Patient continued to complain of pain in her right arm and rated her pain a 9/10.

Further review of the Patient's medical record did not evidence a physician re-evaluated and or continued to evaluate the Patient when interventions were ineffective.

Based on interview and documentation review it was determined 1) the nursing staff failed to esure the effectiveness of pain management and seek further nursing actions despite administering Dilaudid for arm pain that was ineffective, 2.) and failed to ensure all IV assessments were performed acording to Hospital policies/procedures.

Findings include:

Nursing documentation and review of medication administration records at 11:51 and 11:52 AM indicated the Patient complained of 10/10 pain in her right arm and was medicated with 2 milligrams (mg) of Dilaudid (narcotic pain reliever) for the pain.

Nurse #8 documented that at 12:45 PM the Patient continued to complain of 9/10 pain. The Patient's physician was notified and review of medication administration records indicated at 1:29 PM the Patient was administered an additional 2 mg of oral Dilaudid.Documentation at 2:30 PM indicated the Patient's pain was reassessed and was noted to be rated 9. Nursing documentation and medication adminstration records dated 5/23/10 indicated at 3:29 PM the Patient's pain level was 10 and was medicated with 2 mg of Dilaudid. Further review of nursing documentation indicated at 4:20 PM indicated the Patient continued to complain of pain in her right arm and rated her pain a 9. Nursing documentation at 5:02 PM indicated the Patient was discharged to Hospital #2.

Review of Nurse #4's documentation dated 5/21/10 indicated there was no assessment of the IV site documented.

Based on review of one of one applicable medical record the Hospital did not ensure that saline flushes were documented in the Patient's record as required by Hospital policy.

Findings include:

Review of the Hospital's policy/procedure related to Peripheral Line Care and Maintenance indicated all IV locks will be flushed daily when not in use and after every medication administration. The IV will be flushed with 5-10 milliliters (ml) of normal saline using a 10 ml pre-filled syringe.

Review of the Patient's medical record indicated there was no documentation to evidence the Patient's saline locks were flushed per Hospital policy and procedure.

Based on interviews and documentation review, it was determined the Hospital failed to identify all opportunities for improvement during a review of an incident/complaint involving the Patient.

Findings include:

1.) Interview with the Risk Manager and review of the Hospital's investigation regarding the Patient's care indicated the investigation identified nursing documentation issue with Nurse #4. The corrective action revealed the nurse was counseled by her manager. Random review will be performed for compliance.

2.) The investigation did not evidence the Patient continued to be in severe pain despite interventions that included narcotics and there was no follow up medical care and/or evaluation despite ongoing nursing assessment which documented the Patient's pain at 9-10.

3.) There was no re-education provided regarding the alleged injury and IV safety after the Hospital became aware of the Patient's complaint on 6/16/10.

4.) The investigation did not evidence the saline flushes were not documented in the Patient's record as required per Hospital policy.

Based on documentation review of one of one applicable medical record it was determined Hospital Medical Staff failed to continue to assess and/or document assessments of the Patient's right arm and the Patient's response to pain intervention that were determined to be ineffective in relieving the Patient's right arm pain.

Findings included:

Review of medication administration records at 11:51 and 11:52 AM indicated the Patient complained of 10/10 pain in her right arm and was medicated with 2 milligrams (mg) of Dilaudid (narcotic pain reliever) for the pain.

The Attending Physician's medical progress note at 12:30 PM indicated the Attending Physician contacted a vascular surgeon who stated that because the Patient's capillary refill (the rate at which blood refills empty capillaries) in the right extremity was fine, the Patient could be monitored conservatively. However, the actual capillary refill assessment was not found in the Patient's record. The Attending Physician said he called a radiologist in the Hospital and talked with that physician about performing a MRI, however, MRI's were not performed on the weekends.

Documentation at 12:45 PM the Patient continued to complain of 9/10 pain. The Attending Physician was notified and review of medication administration records indicated at 1:29 PM the Patient was administered an additional 2 mg of oral Dilaudid.

At 2:30 PM the Patient's pain was reassessed and was noted to be rated 9/10.

Nursing documentation and medication administration records dated 5/23/10 indicated at 3:29 PM the Patient's pain level was 10/10 and was medicated with 2 mg of Dilaudid.

Nursing documentation indicated at 4:20 PM indicated the Patient continued to complain of pain in her right arm and rated her pain a 9/10.

Further review of the Patient's medical record did not evidence a physician re-evaluated and or continued to evaluate the Patient when interventions were ineffective.

Based on interview and documentation review it was determined 1) the nursing staff failed to esure the effectiveness of pain management and seek further nursing actions despite administering Dilaudid for arm pain that was ineffective, 2.) and failed to ensure all IV assessments were performed acording to Hospital policies/procedures.

Findings include:

Nursing documentation and review of medication administration records at 11:51 and 11:52 AM indicated the Patient complained of 10/10 pain in her right arm and was medicated with 2 milligrams (mg) of Dilaudid (narcotic pain reliever) for the pain.

Nurse #8 documented that at 12:45 PM the Patient continued to complain of 9/10 pain. The Patient's physician was notified and review of medication administration records indicated at 1:29 PM the Patient was administered an additional 2 mg of oral Dilaudid.Documentation at 2:30 PM indicated the Patient's pain was reassessed and was noted to be rated 9. Nursing documentation and medication adminstration records dated 5/23/10 indicated at 3:29 PM the Patient's pain level was 10 and was medicated with 2 mg of Dilaudid. Further review of nursing documentation indicated at 4:20 PM indicated the Patient continued to complain of pain in her right arm and rated her pain a 9. Nursing documentation at 5:02 PM indicated the Patient was discharged to Hospital #2.

Review of Nurse #4's documentation dated 5/21/10 indicated there was no assessment of the IV site documented.

Based on review of one of one applicable medical record the Hospital did not ensure that saline flushes were documented in the Patient's record as required by Hospital policy.

Findings include:

Review of the Hospital's policy/procedure related to Peripheral Line Care and Maintenance indicated all IV locks will be flushed daily when not in use and after every medication administration. The IV will be flushed with 5-10 milliliters (ml) of normal saline using a 10 ml pre-filled syringe.

Review of the Patient's medical record indicated there was no documentation to evidence the Patient's saline locks were flushed per Hospital policy and procedure.