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HARLAN ARH HOSPITAL 81 BALL PARK ROAD HARLAN, KY 40831 April 16, 2015
VIOLATION: NURSING SERVICES Tag No: A0385
Based on interview, record review and review of the facility's policy it was determined the facility failed to ensure a Registered Nurse (RN) supervised and/or evaluated the nursing care for one (1) of ten (10) sampled patients (Patient #2). The facility failed to ensure staff assessed Patient #2's medication allergies upon admission to the facility. Even after Patient #2's family reported that the patient was allergic to Advair Diskus, and that the medication caused chest pain, facility staff attempted to administer the medication on four (4) different occasions.

Refer to A395.
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on interview, record review and review of the facility's policy it was determined the facility failed to ensure a Registered Nurse supervised and/or evaluated the nursing care for one (1) of ten (10) sampled patients (Patient #2). The facility admitted Patient #2 on 04/10/15 with a diagnosis of Obstructive Chronic Bronchitis with exacerbation. The facility failed to ensure Patient #2's allergies were assessed upon admission to the facility as required by facility policy. Interview with Patient #2's Daughter on 04/15/15 revealed she reported to facility staff that the patient could not take the medication Advair Diskus (a medication used to treat breathing difficulties) as ordered by the physician because the medication caused the patient to experience chest pain. The facility failed to report the allergy to the physician as required and failed to ensure the medication was discontinued. As a result, facility staff continued to attempt to administer the medication to Patient #2 twice daily.

The findings include:

Review of the facility's policy titled "Nursing Assessment and Patient Plan of Care," dated 04/08/09, revealed a Registered Nurse would assess each patient admitted to the hospital for nursing care needs within eight (8) hours of admission. The assessment information was to include present medications, past medical history, height, weight, and the patient's allergies.

Record review for Patient #2 revealed the facility admitted the patient on 04/10/15 with a diagnosis of Obstructive Chronic Bronchitis with exacerbation. Review of the Physician's Orders for Patient #2 revealed the patient was ordered to receive Advair Diskus twice daily. Continued review of the medical record revealed the record had no known drug allergies documented for the patient.

Interview with Patient #2's Daughter on 04/15/15 at 11:27 AM revealed she reported a reaction of "chest pain" to Advair Diskus to facility staff. Continued interview with Patient #2's Daughter revealed she was unaware which staff she reported to, but "since telling staff of the reaction, it (the medication) has been brought in four (4) times to be given" to the patient (dates and times unknown). Patient #2's Daughter stated she "had to stop them" from administering the medication to Patient #2.

Interview with Registered Nurse (RN) #1 on 04/16/15 at 9:24 AM revealed she admitted Patient #2 to the facility on [DATE]. The RN stated she had not obtained the patient's allergy information and she had "never assessed allergies" for patients admitted to the facility. The RN stated, "It is the job of the aide to get the patient's height, weight, and allergies."

Interview with Licensed Practical Nurse (LPN) #1 on 04/15/15 at 3:33 PM revealed she had attempted to administer the Advair Diskus to Patient #2 on 04/10/15 at 1:52 PM. She stated the patient's family was present and informed her that the patient "could not take Advair" related to an adverse reaction of "the jitters." The LPN stated she notified the RN on duty (unable to recall who) of the family's reported reaction for Patient #2. LPN #1 stated she had not contacted the patient's physician of the reported adverse reaction to the medication. The LPN stated she was trained to only notify the RN of any reports of adverse reactions to ordered medications.

Interview with LPN #2 on 04/15/15 at 2:08 PM and review of Patient #2's Medication Administration Record (MAR) revealed she had attempted to administer Advair Diskus to Patient #2 on 04/11/15 at 10:28 AM. LPN #2 stated the patient's family had reported that he/she was allergic to the medication, and that the medication caused the patient to experience chest pain. She stated she had been trained to call the patient's physician and report allergies to any medications. LPN #2 stated she failed to contact the physician because she "was busy."

Interview with Patient #2's physician on 04/16/15 at 10:05 AM revealed nursing staff should evaluate patients' allergies to medications. The physician further stated when staff becomes aware of an adverse reaction, or an allergy to any medication, staff should try to get another medication ordered.

Interview with the Chief Nursing Officer (CNO) on 04/15/15 at 4:30 PM revealed staff had been trained to obtain the patient's allergy information when the Admission Nursing Assessment was completed. The CNO further stated staff was required to notify the patient's physician if a patient or family member reported an adverse reaction, or an allergic reaction to any ordered medications. According to the CNO, when Patient #2 was admitted on [DATE], the RN should have obtained the patient's allergy information. The CNO also stated when staff was notified of the patient's adverse/allergic reaction to Advair Diskus, the patient's physician should have been notified.