FH MED STAFF ADMIN - CDPH Home › Programs › CHCQ › LCP › CDPH Document... · 2017-07-05 ·...

7
I i I ! I I I 02/02/2012 14:21 7507289351 FH MED STAFF ADMIN PAGE 02/05 ......... .... ..... " .... " ...... I ' , . ..... " ••• - ..... . ........... .... ... .......... ".- • •, .. " _ ........ , •• . , .. .. __ , ... ...... • • , ... .. __ ... " .... . ....... . .. , _ ... .. . .... _ ... .. .. " ............. .. ... 0+. _ ... _ .... _ ... ............ " "'"" .. ' ... _,.. ....... , . .. ..,.... .... , ..... .... n. "" ... .. _ .. '''''.,,_, .... , ...... '" .. CAL;IFORNIA 1i1:1l,L TH ANtJ HUMAN SERVlCES AGENCY DEFtARTMENr ' OF puaLle HEAl.TH AND Pl.ANOF ctlllJl!!C'T,QN IXI) f'11.0vI OEfVSUr>PLleRIClIA I OEm'!"tCA'hO'4 NUMfl!!R: (X31I.lATF. 060435 lI,e UILPING e,.VI1NG 01100(2012 NAt.4IHJI' I'ROWlE!ROR FAI.t.:SROOI< HOSPITAL ):llS'rRICT STllli'tilAOORES'll. ' (!lTV. STAtlt.·ZIP· COOE B·24, £.ELOEllST., FALl..aROOK,.CA 92028 SAN OTEGO COUNTY T/IG \ I I SUMMAA.Y'l;TATEMEm OF Ofg'rclllNCIU OEFlclGN'CY l;Iuar 9E l?tlECEI!Ol!D: OV RteVLATORY OR lSC 1'DF.mII'YINOlNl'Oll!MTIQN) I following rriects, flnd f ngsof the Department j or Public Healih during an InspectJon vlsil: I ! Complairlt Intake Number: ! CM0254765 ' Substanllated i Representing the Dspartment of Put1!it:; Heel1h; i 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-l ealltr snd Safety Code 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 $;9rl0\1s I i Injury or deaU, to lhepatlent. I j Informed AdverseE\fenl Notlflcation Health and I ; Safely Code Section 1279."1 (e) . Qhall i ! infotrit the patienl or the 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 pat ient of tl10 ! \ atJvetge Gventby thetimntl1e report was made. ' 10 I Prtt;FIX TAG ! I P!1(lVIt;)E (ttACrl. 06RRECT'VE 1\(;1100 GHO\lLO as CFtOSS- AEi'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 0"'1'\; 1 , 1Z79.1 (b) (4) (Al A patient death or 1IO[IOU3 , " r J dlSBbililyassoCI1:lled \'Inti a _tl_o_ n_e_rr_o_t· ___ __ __ __ ______ ........ I ___ --J 1I10/2e,2 10;33l37AM iI\'wdatiCla r;:y m) ssiOrllk (') R deactency · 11'.oy bHXCll$!id. from 'corroctlng It thnt ' OlJlft( 311ffiefMI proti><:tiorl to IhO ror nbove dI!Ic1l»nhll> OO: daya /bilt.lWlr>g tile' dftlft pion ()J oo. rrec1lon '$ For o'J.,l ng I\Om"I!, ltTO ebovQnlldlngoQi'I(! 'piBn!< of eorroell on Bre 11) 11'10 dlltolHOi;o Ill'!) mode 10 Ihe If 1)fueited, 00 01 eori'Odio" I; reqvitM IQ Pl'OQl'llm St,ne-2S 01 'en

Transcript of FH MED STAFF ADMIN - CDPH Home › Programs › CHCQ › LCP › CDPH Document... · 2017-07-05 ·...

Page 1: FH MED STAFF ADMIN - CDPH Home › Programs › CHCQ › LCP › CDPH Document... · 2017-07-05 · ; care shall be developed, maintained and : implemented by the nursing services

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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

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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

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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

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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

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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

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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 ,

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6017

Page 7: FH MED STAFF ADMIN - CDPH Home › Programs › CHCQ › LCP › CDPH Document... · 2017-07-05 · ; care shall be developed, maintained and : implemented by the nursing services

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.

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