FH MED STAFF ADMIN - CDPH Home › Programs › CHCQ › LCP › CDPH Document... · 2017-07-05 ·...
Transcript of FH MED STAFF ADMIN - CDPH Home › Programs › CHCQ › LCP › CDPH Document... · 2017-07-05 ·...
I i
I !
I I
I
02/02/2012 14:21 7507289351 FH MED STAFF ADMIN PAGE 02/05
......... .... ..... " .... " ...... I ' , . ..... " ••• • ~ .--.- - ..... . ........... .... ... .......... ".- • • , .. " _ ....... . , •• ~ . , .. .. __ , ... q~ ...... • • , ... .. __ ... " .... . ....... ".~_, . .. , _ ... .. . .... _ ... .. .. " ............. .. ... 0+. _ ... _ .... _ ... ............ " "'"" .. ' ... _,.. ....... , . .. ..,.... .... , ..... .... n. "" ... , ~ > .. _ ~ .. '''''.,,_, .... , ...... '" .. ,,_ ~.
CAL;IFORNIA 1i1:1l,L TH ANtJ HUMAN SERVlCES AGENCY DEFtARTMENr 'OF puaLle HEAl.TH
S l'J\Tg,.~N1' Cr.bEflO<'ENCI~S AND Pl.ANOF ctlllJl!!C'T,QN
IXI) f'11.0vIOEfVSUr>PLleRIClIA IOEm'!"tCA'hO'4 NUMfl!!R:
(X2) .MU1.1lf'L~$OMSTllUCTION (X31I.lATF. ~l1I'lVl!Y COM~~1E!O
060435 lI, eUILPING
e,.VI1NG 01100(2012
NAt.4IHJI' I'ROWlE!ROR Slllr?~I1'.R
FAI.t.:SROOI< HOSPITAL ):llS'rRICT STllli'tilAOORES'll. '(!lTV. STAtlt.·ZIP·COOE
B·24,£.ELOEllST., FALl..aROOK,.CA 92028 SAN OTEGO COUNTY
(X~) .IO i>1i~(.I)(
T/IG
\
I I
SUMMAA.Y'l;TATEMEm OF Ofg'rclllNCIU (l!AO~ OEFlclGN'CY l;Iuar 9E l?tlECEI!Ol!D:OV r-tlt~ RteVLATORY OR lSC 1'DF.mII'YINOlNl'Oll!MTIQN)
I Th~ following rriects, Ih~ flndfngsof the Department jor Public Healih during an InspectJon vlsil:
I ! Complairlt Intake Number: ! CM0254765 ' Substanllated
i Representing the Dspartment of Put1!it:; Heel1h; i SUIV~yl)r 10'# 22363, HFEN , : 1 Thelnspe:c1lCm wBslJrnfted to the speolfic'faclllty I event investigated and does not represent .the I flndings 01.'6 fvl!·lnspeetlon 01 thefllcillty.
I l-lealltr snd Safety Code $~ction 1280.1(0): -F"(Ir
I, purposes of this fioc::llon "Immediate jeopardy" mea:19 3 situation In which the licenses's noncompll'ance with one or more reqtlir.emerlts of J
j l/censure has caused, or Is IIk<lly tOOQIJ~Q, $;9rl0\1s
I i Injury or deaU, to lhepatlent.
~ I
j Informed AdverseE\fenl Notlflcation Health and I ; Safely Code Section 1279."1 (e). PThefacfli~' Qhall i ! infotrit the patienl or the p~rty roopot1l.libla for the ! i patient of Ihe I)dverse event by the tJmo the report ' is made .. "
i ' The CD?H verified 1ha! the facility ir'lrormed the ' ! patient (,If the party responsible for the patient of tl10 ! \ atJvetge Gventby thetimntl1e report was made. '
10 I Prtt;FIX TAG !
I
P!1(lVIt;)E ~a"1;:'N'OF COIit~EC'lIQt./
(ttACrl.06RRECT'VE 1\(;1100 GHO\lLO as CFtOSSAEi'ERSNCi;O to 'n1l1M'P'/loflmA'lIrtlEr.ICI),::HCY)
r
i i
I i! j 1279:! (b) For purposes of this sectio'n "advers-e I ! I : eIIent" ii1Cludes Driy:of the following: I i I
IX~)
COMI'~e1$
0"'1'\;
1
, 1Z79.1 (b) (4) (Al A patient death or 1IO[IOU3 , " r
JdlSBbililyassoCI1:lled \'Inti a med~ea._. _tl_o_n_e_rr_o_t· ___ ~:-:::-:i.i __ -.~I~~-__ ~ __ ~, ______ ........ I ___ --J
1I10/2e,2 10;33l37AM
iI\'wdatiCla r;:y st~IQtn6ni~dIMwnh m) ssiOrllk (') de"ot~~ R deactency w~lt~ thIY jll~li\l11on ·11'.oy bHXCll$!id. from 'corroctlng prov!~ill9 It I~ ~tqll'llln(~ thnt 'OlJlft( ~(oauE!jij$IlfO'l'l<lO 311ffiefMI proti><:tiorl to IhO ;;>stklnt~, E"~pt ror rtur.ln~ hor"\I~. (h~l\ool"il' nbove ~re dI!Ic1l»nhll> OO:daya /bilt.lWlr>g tile' dftlft O(S~MY Whet~\lt¢tnoI9 pion ()J oo.rrec1lon '$ ~lovidD4. For o'J.,lng I\Om"I!, ltTO ebovQnlldlngoQi'I(! 'piBn!< of eorroellon Bre dlsclo~ElbIo 11) (1~yj\l roR""~"il 11'10 dlltolHOi;o doelJi"r<1l\I~ Ill'!) mode (\~il(lbIO 10 Ihe r~~llty , If d~ne'lI~eIM 1)fueited, 00 8ppt'(jvo~plon 01 eori'Odio" I; reqvitM IQ ~Q/Ilinuod Pl'OQl'llm p,,~lpMien.
St,ne-2S01 'en
CAlIFGRNIA HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF PUBLIC HEALTH
STlITEMEN1 OF ()(, nCIENC'e$
AND I' LAN OF CORRECTION
(X I) PROVIDEH/SUPPUERfCLlA
lDENTIF1CATION NUMBER:
(X2) MUll'IPLE CONSTRUCTION (X3) [If,TE SURVEY
COMPLETED
050435 A BUILDING
8. W1NG 01/0612012
NAM!' OF PROVIDI, f, OR SUPPLIER STREET ADDRESS . CITY, STATE. ZIP CODE
FALLBROOK HOSPITAL DISTRICT 624 E. ELDER ST., FALLBROOK, CA 92028 SAN DIEGO COUNTY
(X4) 10 , ,
PI,EFIX ! SUMMAR'I STArEMENf OF DEFICIENCIES
(EACH DEFICIENCY MUST BE PHECt:EDED BY FULL
REGULATOHY OFl LSC IDENTIFYING INFORMATION) T~.G
Continued From page 1
jncluding. but not limited to, an error involving the ' wrong drug, the wrong dose, the wrong patient, the ' wrong time, the wrong rate, the wrong preparation, or the wrong route of administration, excluding
[ i
reasonable differences in clinical judgment on drug l
selection and dose.
: 70263 (g) (2) Medications and treatments shall be : : administered as ordered. i 70215 (b): The planning and delivery of patient care ; ; shall reflect all elements of the nursing process: } assessmenC nursing diagnosis I Planning. ! I : intervention, evaluation and, as circumstances i require. patient advocacy, and shall be initiated by : a registered nliise at the time of admission. ' 70213(a) Written poliCies and procedures for patient , ; care shall be developed, maintained and : implemented by the nursing services .
• 70213(b) Policies and procedures shall be based : : on current standards of nursing practice and shall ! be consistent with the nursing process which ' includes: assessment, nursing diagnosis, planning, i
' intervention, evaluation, and , as circumstances i i require , patient advocacy.
' Based on interview and record review, the facility failed to ensure that Obstetric/Newborn nursery ,
i staff implemented its policy and procedure related ' to the delivery of medication to a newborn baby ; , patient (Patient A) following delivery. As a result, Patient A received an injection of Methergine (medication used for the prevention and control of
, postpartum hemorrhage in mothers following . delivery) following delivery. The metilergine injection was intended for Patient A's mother. The
Event ID:707611 1110,12012
10
PREFIX
TAG
,
PHOViOErrs PLAN OF CORHECTION (EI\C II COHHECTIVE ACTION SHOULD BE CROSS·
F< EF Efl E NCf:() TO THE APPROPRIATE IJEFICIENCY)
10:33:37AM
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE
Any defickmcy statement endln(J Witrl an asterisK (') denotes a doficlency which the instit(llion may oe excused (rom correcting providing it is determined
that other safeguards provide sufficient plOtectiorl to the patients, Except for nurSing homes. the findings above are disclQsab!e 90 days following the date
of survey whether or n01 a plan of correction ;s provided. For nursing homes. tl1t, abo'/e findings and plans of correction are disclosable 14 days following the dale these documents are made available (0 Ille faCility. 11 defiCiencies are cited. an approved pian of corniclioll is requlsi!e to continued program
particlpalion
St11le-2567
(X6j
COMPl.El'c
Ot'lTE.
(X6) DATE
2 of '7
CALlFGRNIA HE,o..LTH AND HUMAN SERVICES AGENCY DEPARTMENT OF PUBLIC HEALTH
Sl 'AT[£MENT or (lEfICIENCIES
ANO PtAN or CORRECTION (X1) PllOVIOI::RISlIPPUEHICtlA
IDENTIFICATION NUMBER (X2) MULTIPLE CONSTRucnON (X3) DArE SURVEY
COMPLInED
050435
A. BUILDING
B.\'\1NG 01/06/2012
NAME or- PROVIDEr, OR SliPPlIEr~
FALLBROOK HOSPITAL DISTRICT
STREET ADDRESS. CITY. STATE. ZIP CODE
624 E. ELDER ST., FALLBROOK, CA 92028 SAN DtEGO COUNTY
(X4)ID
f'H/; cIX
TAG
SUMMARY STATEMENT OF DEFICIENCll,S
(EACH DEFICIENCY MUST 8E PRECEEOf:D BY FULL HEGULATORY OR LSC IDENTIFYING INFORMATION)
: Continued From page 2
!
Obstetric/Newborn nursery staff further failed to intervene or advocate for the patients as it related to ' reporting the medication error to the baby's or the . mother's physician in a timely manner. Patient A ; developed seizures and required emergency : transfer to another hospital, as well as endotracheal ;
! intubation (insertion of a tube into the trachea to ! i establish an airway) , multiple tests and treatment . for seizures acquired secondary to the injection of methergine
Findings:
' Patient A, a newborn baby, was delivered at tile ' , facility on . 11 at 11 :44 p. m. according to the i
Physician Record of Newborn Infant. Per the same j
record, Patient A was a normal spontaneous I vaginal delivery, 91bs 11 OZ, with Apgar scores of 8
I and 9 at 1 and 5 minutes. (The Apgar score is I based on breathing heart rate, muscle tone, reflexes and skin color. The 1 minute score determines how well the baby tolerated the birthing , process and the 5 minute score determines how
, well tile baby is adapting to the new environment. ; Scores of 8 or 9 are normal).
i ; Following delivery the physician in the delivery room i ; ordered methergine for Patient A's mother. RN 1 ! ! administered 0.2 m9 of methergine intramuscularly : , to Patient A, the mother's newborn baby. According , i to the medication delivery system (pyxis) readout ; , . and interview with the pharmacist, the first dose of i
methergine was removed at 12:01 a.m. A second : dose of methergine was later removed from the
: pyxis at 12:03 a.m., which was then delivered to , , !
Event ID:7G7611 1/10/2012
JO PREFIX
TAG 1 ;
PROVIDER'S PLAN Of CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE CROSS· REFERENCED TO HIE "PPROPI~IIITE DEflCIENCY)
Preparation and/or execution of this Plan of Correction (POC) does not constitute admission or
; agreement by the provider of the 1 conclusions set forth on the Statement of Deficiencies. This POC is prepared because it is required by the provisions of Health and Safety Code.
:L-__________________ . ____ . __________ ~ i
10:33:37AM
LABORATORY DIRECTOR'S OR PROVIOER!SUPPLIEH REPRESENMT)VE'S SIGNATUHE TITLE
Any deficiency statemenl ending with an asterisk (0) denofes a deficiency which the Institution may be excused from correch"9 providing it is determ,ned
that other safeguards provide sufficient prolection 10 the pollents, Excepl for nursing homes, the findings ~bove are disclosable 90 days follOWing the dale
of survey wllelllCr or rot a f>I<l11 of correction is provided. For nursing homes, the above findings and ptans of corroction are disclosable 14 days following
the dalo Ihose documents are made available to tile facil ity . If deficiencies ere ciled, an approved ptan of correction is requisile to continued program
pPitic'palion,
(X5)
, COMPLETE
DATE
(X6) DATE
State.2567 3 of 7
CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF PUBLIC HEALTH
STAlEMENI OF DEFICIENCIES
AND PLAN OF CORREC'flON (Xl) PHOV IDEH!5UPPUERIClIA
IDENTIFICATION NUMBER (Xli filUL TlPLE CONSTRUCTiON (X3) DATE SURVEY
COMPl.ETED
050435
fo. flUII.[)ING
B. Vv1NG 01/06/2012
NAME OF PROVIDEf1 OR SUPPI.IER
FALLBROOK HOSPITAL DISTRICT
STREE'T ADDRESS. CITY. STATE. ZIP CODE
624 E. ELDER ST. , FALLBROOK, CA 920.28 SAN DIEGO COUNTY
()(4) 10
Pfl EFIX TAG
SUMMAHY STATEMENT OF DEFICIENCltS
(EACH DEFICIENCY MUST BE. PRECEIWED OY FULL
REGULATOr,y OR LSC IDt:NnFYING INFORMAriONi
I Continued From page 3
I ! I
! Patient A's mother, according to RN 2. no documentation to indicate Patient A
There was ; was given I
methergine.
i According to The Physician Record of Newborn i Infant, the pediatrician was not notified until approximately 2:35 a.m. on _1 that Patient A received methergine following detivery at 12:00 a.m. The pediatrician noted that nursing reported seizure
• like movement from Patient A at 2:30 a.m. VVhen the pediatrician arrived. at approximately 3:00 a.m Patient A was noted to be '· ... periodically groaning. :
i doesn't open eyes ... tonic clonic seizure like ! ; movemen!..." Phenobarbital (seizure medication) ' was administered at 3:21 a.m. and shortly i thereafter the seizures subsided. Patient A was . transported to Hospital 2 at 4:50 a.m. and arrived at
· Hospital 2 at 6:40 a.m, Shortly after arrival Patient I A was intubated and placed on mechanical ! ventilation . Patient A was noted to have "acute metllergine poisoning" was placed on Phenobarbital ; for seizures and nitroprusside for hypertension (high ; btood pressure) . Patient A was eventually discharged on _ 11. According to the physician's report Patient A will require further . neurological examinations due to ischemic injuries ; (damage or death to brain tissue) seen on an MRI ' (Magnetic Resonance Imaging) of the brain.
· The Initial Newborn Profile and the PI1ysician Record of Newborn Infant were reviewed with administrative staff on 1113/11 . There were 2
; registered nurses and 1 physician during the ' delivery of Patient A. According to administrative staff, generally one RN was assigned to mother and i
Event ID.7G7611 1/10/2012
ID f'HEfIX
lAG
i I
P'{OVIOEfl'S PLAN or CORHECTION
(EACH CORRECT'lVE AC TION SHOULD BE CHOSS·
flEFEHENCED TO THE APPflOPRIATE DEF,CIENCYi
i , ! , ;
r.---~~~~~--~----~~ i Immediately following the event, the : : Chief Nursing Officer (CNO) i reviewed existing policies and i procedures governing: • Notification of adverse events • Chain of command • Admin istration of medications No revisions to the po licies were
; found to be necessary. The two I ind ividuals directly involved in the
event were subject to disciplinary actions in accordance with the hospita l's policy and procedure.
!
10:33:37AM
IX5)
Cm.1 Pl.ETE DATE
E'J/09/ 2012
LABORflTORY DIREC TOR 'S OR PR.OVlDER/SUPPLIER HEPHESENTATIVE'S SIGNATURE TITLE (X6) DATE
Any deficiency slatement ending with an <:Jsterisk (') denotes a deficioncy which the instilullon may 00 eXCused from correcting providing It is determined
that oiher safeguards provide sufficient protection to the palients. Except for nursing homes. the f",d ings above are disclosable 90 days following tho datn
of s Uivey whether Of nol a plan of correclion is provided. For nursing homes, the above findings and plans of correc1ion ara disclosabl~ 14 days fol lowing
the date these documents ~re made av~ilable to the faci lily . If deficiencies are cited . an approved plan of correction is requisite to continued program
participation.
4 of 7
CALIFORNIA HEIl,L TH AND HUMAN SERVICES AGENCY DEPARTMENT OF PUBLIC HEALTH
srATUvll:NT OF OI, HCIENCIES ,\NO PI.AN OF CORr~ECTION
(Xl) PROVIOEf<iSUPPLIERICL!A
IPENTIFICATION NUMllEH: IX2) MULTIf'LE CONSmUCTION IX:S) DATE SUIWEY
COMf'lHED
050435 AIlUIWING
Il . WlNG 0110612012
NAME OF PROVlDER OR SUPPLlEI~
FALLBROOK HOSPITAL DISTRICT
STREtT ADPRESS, CITY, STATE, LIP COPE
624 E, ELDER ST" FALLBROOK, CA 92028 SAN DIEGO COUNTY
(M) ID
PREFIX TAG
SlJMMi',RY STATEMENT OF DEFICIENCIES '.[t,CH DEFICIENCY MUST BE PRECEEDEO BY FULL
REGULATORY OR lSC IDENTIFYING INFOI'Mr.TIO N)
Continued From page 4
1 to baby. bLlt it was not each other out during following the delivery the care of mother and child,
uncommon that they help the delivery, Typically
mother's nurse assumes
: ,
: RN 2 was assigned to Patient A, and spoke about : : the incident during an interview on 2/3/11 at 7:30 : a.m. According to RN 2. she recalled PhysiCian X !
: requested melhergine for Patient A's mother i • following delivery due to uterine bleeding. RN 2 : recalled leaving the room to get the methergine for i
mom, RN 2 returned with the methergine and : handed it to RN 1 RN 2 stated RN 1 wasn't doing : anything with the methergine, so RN 2 drew up the : methergine and handed it to RN 1, RN 2 stated she watched RN 1 place the adult needle on the methergine and then turn and give the injection to the baby (Patient A) instead of the baby's mother, ' RN 2 recalled saying "What are you doing?" to , which RN1 replied "What?" RN 2 recalled telling RN :
1 "You just gave the methergine to the baby" According to RN 2. RN 1 then stated "Oh my God what did I do,,:' RN 2 then retllfned to the pyxis and retrieved another dose of methergine for Patient A's mother. RN 2 stated she saw RN 1 leave the
· room after Physician X and assumed RN 2 was following the physician to tell him what had just happened. According to RN 2, approximately 15 minutes later she discovered RN 1 hadn't notified the physician, RN 1 suggested to RN 2 that she call the pediatrician on call and tell him about the melhergine she gave to Patient A RN 2 stated an I
: hour later RN 1 had still not notified the i
· pediatrician, According to RN 2 she observed RN 1
! looking up methergine on the internet for side
Event 10' 787611 111012012
ID PR!!F!X
TfI,O ;
[
PROVIOr:f('S PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE CROSS· f{EFER~NCEo 1'0 IHf: N'I'ROPRIM[ DfF/Clnley)
Upon completion of the policy , reviews, the eNO provided education to all nursing staff regarding: • Immediate reporting of adverse
: events with notification to phYSician · and other appropriate individuals. • Nursing and organization-wide
; chain of command processes to be ; followed to ensure appropriate · notifications are completed. : • Appropriate processes in medication administration, including: o Following the 5 rights of
; medication administration
o Using two patient identifiers prior ! , to administering medications
o Implementing verbal orders with a say back' process that is repeated
; after medication is obtained and i : prior to administration i 0 Administering only those medications for which you possess
· knowledge of the medication's , actions, usual dose, route, side : effects and any special considerations in administration , IL-----___________________________ -"
I 10;33:37AM
(X5)
COMPLeTE (). .. \TE
J709T 2012
LAflORATORY DIRECTOI'<'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATUI'<E TITLE (X!;) DATE
Any deficiency stalement ending vAlh an asteriSK ('J denotes a defiCiency wllich the ;n6\llulion may be excusact from cOffeeling providing ;t IS detelmined
that other safeguards provide sufficient protection /0 Ihe palients, Except for nurs ing homes. the findings ~boye are dlsclosabla 90 days following the dale
of sL,Ney whelher or no! a plano! correction i, provided, For nursing homes, 1M above findings snd plans of corre·clioll are disdosabl9 14 days following
the date thasl) documents are made available to Ihe facility. If deficiencies are cited, an approved plan of correction is requls,le tQ continued program
par1iclpatiol1 ,
5017
CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF PUBLIC HEALTH
SlAl"fMIiNT or DEFICIENCIES
AND PIAN OF CORHECTION (X f) PI~OVIDER!SUPPLIERICLIA
IDENTIFICr,TlON NUMBER: (X2) MULTIPL E CONSTRUCTION (X3) DATE SURVEY
COMPLETED
050435
A, BUILDING
IJ, WING 01/06/2012
NJ\t.1E OF PROVlDER OR SUPPLIER
FALLBROOK HOSPITAL DISTRICT
STI~EEl ADDHESS, err'r. STATE, ZIP CODE
lX4)ID PI,EFlX
lP.G
624 E. ELDER ST" FALLBROOK, CA 92028 SAN DIEGO COUNTY
SUMMAIW SVITEMENT OF DEFICIENCIES
(E/\CH DEFICIENCY MUST HE PHEC[EOED 8Y FULL
f<EGUlP.TOf~Y Oil LSC IDENTIFYiNG INfOf{MATlON)
t I , ,
; Continued From page 5 i I ,
l effects , RN 2 stated she noted seizure like activity ' i from Patient A at approximately 2:30 a,m, that I ! morning and then RN 2 notified the pediatrician on
! call.
RN 1, who was assigned to Patient A's mother, declined to interview.
i !
Physician X (the obstetrician WilD delivered Patient • • A), spoke about Patient A on 1/10/11 Physician X recalled both nurses were in the room when he asked for methergine but did not recall any :
! problems reported to him at that time when the · nurse administered tile medication. According to , , Physician X tle wasn't notified that anything had , , gone wrong until he came In the next day . · Physician X stated that he would have expected to . i be notified right away. Physician X further stated i : that had he been notified he would have taken : • aelion immediately and called a pediatrician,
10
PREY1X TAG
f'/{OVIL)!iH'S PLAN OF COH!<ECTION
lEACH CORI~~ClIVC AcnON SHOULD s!, CROSS, REFERENCL'.D ro THE APf'ROPHIA TE L)tnCIENCY)
Immediately fol lowing the event, the Human Resources Director audited personnel flies of all licensed nursing staff assigned to the Women's Center to ensure that they had received education during their orientation period concerning event reporting and disclosure. This orientation process will be implemented for any newly hired member of the nursing staff.
CNO and Director of Human Resources modified the organization's Annual Employee Update and Skills Fair to include immediate disclosure of medication errors, Completion of the Annual Update and Skills Fair is required of all licensed nursing staff including House Supervisors,
(X5)
COMPLETe
DATE
TIo9/ 2012
"'---
! The house supervisor (HS) on the evening of . 11 : : to • 1 was interviewed on 2/10/11, According to i · the HS no one notified her of the Incident. The HS ' recalled hearing a page requesting respiratory
=--:-:- " The Human Resources Director and/or 2;06/
2012 I services to the newborn area. finding this unusual, ! she followed respiratory to the newborn nursery " When the HS arrived at the nursery. she overheard :
: the nurses talk ing about poison control. When she 1 inquired as to the reason, RN 2 explained the baby had received methergine following delivery, According to the HS, the nursery was not busy that evening and only had 1 del.ivery,
The facility's policy and procedure entitled
Event ID:7G7611 1110/2012
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNi\TURE
the CNO will audit records of : orientation and ongoing education : regarding medication administration, error/adverse event reporting and disclosure to ensure that all licensed nursing staff members have received the appropriate education and demonstrate ongoing competence to administer medications.
10:33:37AM
TITLE
Any deficiency stslament ending with an asteris~ C') denotes a deficiency which the institution may be excused from correcting providing it is determined
that otller safeguards provide sumelent protection to tila patients, Except for nursing homes, ttle findings abova are disclosapls 90 days following the dale
of survey whether or not u plan of correction is proVided, For nursing homos, the above find.ngs and plan$ of correction are disclosatl le 14 days fOllowing
tile date these docurnenls are made available to Ihe faci lity If defociencies are cited; an approved plan of correction is requisite to cOI1\lnued program
palt ,clpation ,
8101 0-2567
(XIl) I)ATE
6017
CALIFORNIA HEo.UH AND I-IUMAN SERVICES AGENCY
DEPARTMENT OF PUBLIC HEALTH
SI ATEMENT OF DEFICIENCIES AND PLAN or COf{f,EcnON
(Xl) PROVIDEHiSUPPlIERiC.II\ IDENTIFICATlON NUMBEI<'
(X2) MUL TIPI.E CONSTRUCTION (X3) DAlE SUHVEY
COMPLETrU)
A. BUILDING
050435 B. VJlNG 01106/2012
NAME OF PROVIOfiR OR SUPPLIER
FALLBROOK HOSPITAL DISTRICT
smEET ADDRESS , CITY. STATe liP CODE
(M)ID
PREFIX TAG
624 E. ELDER ST., FALLBROOK, CA 92028 SAN DIEGO COUNTY
I SUMMARY STATEMENT or DEFICIENCIES
(EACH DEFICIENCY MUST BE PRECEEDED BY FULL
REGULATORY OR lSC IDIiNTifYING INFOflMATION)
Continued From page 6 I
Medication Use and Administration was reviewed ; with administrative staff on 2/10111. According to : the policy. patient identification should be verified . pr.ior to the administr.atiDo of any medication, using I , 2 Identifiers. The policy furtller sllpulated that the I
licensed health care practitioner will have , . knowledge of the actions, uses. normal dosage . . ! route, side effects and special considerations ' i before administering the medi,cation. The policy i
further detailed the requirements to accurately I document all medications administered as well as physician notification of medication administration , errors. !
ID PREFIX
TAG
;
,
PROVIDEI{'S PI.AN OF CDRHECTION (EACH CORRECTIVE /I.cnON SHOULD BE CROSS-
REFERE,NCFD TO THE ,\Pi'HOPWATE DEFICIENCY)
Any instance of noncompliance will -: be immediately referred to the I
, Nursing Unit Manager. Results of , i the auditing will be summarized and !
, reported monthly to the Quality • Improvement Committee, Medical I I Executive Committee and Governing : ! Board. Monitoring will continue '
until at least one full year of compliance has been reported.
The Risk Manager will monitor reported medication errors to ensure ; timely disclosure of the errors has
IX5) COMPLETE
DATE
~
2/06/ 2012
- -
' The facility failed to ensure that Obstetric/Newborn ; : nursery staff intervened, and advocated on behalf of ; Patient A after injecting the newborn (Patient A] .
: with a medication ordered and intended for the i ! newborn's mother. The facility staff failed to identify i Patient A prior to medication administration llsing !
12/06/ 2012
i L..........; noncompliance will be immediately ; I addressed with the Nursing Manager
occurred . Instances of
two identifiers per the facility policy. The facility ' : failed to ensure nursing staff were informed of the ' medication and its potential side effects prior to , administration. Finally. the facility nursing staff i failed to inform the physician immediately after the : known administJ'ation of methergine to the newborn ! infant (Patient A) rather than to the mother.
These deficiencies. jointly, separately or in any : combination, have caused or are likely to calise serious injury or death to the patient. and therefore . constitute an immediate jeopardy within the meaning of Health and Safety Code section 1280.1(c).
Event ID:7G7611 1/10/2012
LABORATORY DIREGTOrrS OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
: of the involved nursing unit and the I CNO. Results of the monitoring will be summarized and reported monthly to the Quality Improvement Committee, Medical Executive Committee and Governing Board . Monitoring will continue until at least one full year of compliance has been reported.
L-__________________________ ~
10:33:37AM
Tnt.E
Any deficiency slatement ending with al1 asterisk (') denotes a deficiency whiel, the instituHon may be excused from correcting providing il is determined
tl1al other safeguards provide sufficient protocliofl to the patients. Except for nursing homes. the findings above are disclosable 90 days following Ihe date
of survey whether or not a plan of correction is provided. For nursing homes, the aboye findings and plans of correction are disclosable '4 d,lYS follOl'ling
the dat" thase documents are made available to If,,;! facility, I f daficiencies ore cited. an approved plan of correction is requisite to continued program
parlicipation.
Slalo'-2567
i J ,
(X6) DArE
7 of 7