WASHINGTON HEIGHTS NURSING HOME

Facility I.D. Number 0042044
1010 W. 95TH St.
Chicago, IL 60643

Date of Survey 06/14/00

Incident and Complaint Investigation

"A" VIOLATION(S):

General nursing care shall include at a minimum the following and shall be practiced on a 24-hour, seven day a week basis.

All treatments and procedures shall be administered as ordered by the physician.

This REQUIREMENT is not met as evidenced by:

Based on physician and staff interviews and facility record reviews, facility failed to follow physician's orders from the transferring hospitals for 2 of 2 residents located on the second floor.

1. Medical record review reveals R#11 admitted on 5/25/00 with diagnosis on Transfer form "Osteomyelitis" and diagnoses on Nurses Notes "D.M. [Diabetes Mellitus], HTN [Hypertension], CHF [Congestive Heart Failure], VRE of Urine [Vancomycin-Resistant-Enterococcus], Renal Insuff. [Renal Insufficiency], Hx of CVA [History of CardioVascular Accident], Central line to L Subclavian, and G-Tube.... Foley Catheter...Bed sore to sacral area..". Transfer form under current medications indicated "See Medication Sheets". The medication sheets from the hospital indicated 0600, 0900, 1800,and 2100 as the medication dose times. The med sheet for 5/25/00 indicates the 0600 time lined out. The med sheet includes "NPH Insulin 43U q618" and to the right of the entry is written 0600,1800; and "Accuchecks q618" and to the right of the entry is written 0600,1800; "Reg.Insulin
   201-250=3U
   251-300=5U
   301-350=7U
   351-400=9U
   >400=CALL MD"
   
   
   Nurses Notes start 5/25/00 at 1p.m. Facility had knowledge of R#11's med schedule at least 2 days prior to this admission. A copy of the medications sheet found in the record documents a fax date and time line as "05/23/2000 10:12 a.m....." Care Plan dated 5/25/00 documents "NPH Insulin 43 units Subcue Sliding Scale
   201-250=3U
   251-300=5U
   301-350=7U
   351-400=9U above 400 call MD."
   
   
   Hospital records titled 'Problem List' document 3/8/00 "altered metabolism" "unstable blood sugar" and an undated sheet with a fax date and time of 5/23/2000 10:08 a.m..."very large about 20 x20 cm deep sacral and coccygeal decub".
   
   
   Nurses Notes on 6/1/00 at 10 a.m. document...."receiving 8 L O2 per nasal mask, experiencing labored breathing. Resident lethargic...T.102.1 P 105 R 25 B/P 168/72....Doctor paged...send to hospital."...because of Resident's unstable vital signs ..to Little Company of Mary Hospital" "admitted..Sepsis".
   
   
   Interview with E3 on 6/7/00 revealed that facility became aware that R#11 had not received her scheduled insulin and proper care for her documented diabetic condition when hospital called and questioned R#11's elevated blood sugar history on 6/1/00.
   
   
   Phone interview with Z#6 on 6/13/00 reveals R#11 hospital admission Blood Chemistry at 8 p.m. is recorded as 675mg/dl with normal values within the range of 65-115 mg/dl. E#3 stated that E#9 admitted to E#3 that he was unable to decipher the transfer order sheets and determine when the meds should be given as well as the accuchecks because he was not familiar with military times. Facility then suspended E#9 for three days in response. Phone interview on 6/13/00 with E#9 reveals that E#9 was suspended for failure to monitor R#11's chart. Phone interview on 6/13/00 with E#11 states tried to 'contact nurse at hospital','was placed on hold' and did nothing more. No evidence of any NPH Insulin 43 U twice daily, Accuchecks twice daily, and use of Regular Insulin sliding scale for R#11 from admission of 5/25/00 to discharge of 6/1/00, a total of 8 days.
   
   
   2. R#1 admitted 5/10/00 with diagnoses on face sheet documented as "G-Tube, Decubitus Ulcer, CVA [Cardiovascular Accident], HTN [Hypertension], Dysphasia, NIDDM [Non-Insulin Dependent Diabetes Mellitus]. Physician phone orders for 5/10/00 document similar as documented on Northwestern Memorial Hospital Continuity of Care form under Discharge Plan with the addition of 1.] Vit C 500mg via PEG tube BID, 2.] FeSo4 220mg liq daily via PEG tube. R#1's Medication administration sheets document these medications given as ordered with the exception of Vit C, documented as given one time a day instead of twice a day. R#1's medical record also included a separate Northwestern Memorial Hospital Patient Discharge Instructions documenting physician orders for:
   
   
   1.] Cardura 4 mg every hour of sleep,
   2.] Atenolol 50 mg every day,
   3.] Plavix 75 mg every day,
   4.] Glipizide 10mg every a.m.,
   5.] HCTZ 12.5 mg every day,
   6.] ASA 81 mg every day,
   7.] Dulcolax 10 mg prn,
   8.] Colace 100mg twice a day,
   9.] Prevacid 30mg every day, and
   10.] Heparin 5000 U sq twice a day.
   
   
   R#1 was without these medications from 5/10/00 to 5/17/00, a total of 7 days. Z#2 interview on 6/9/00 reveals Z#2 was informed by the facility on 5/16/00 that another paper was located "in the bundle of hospital records" listing these medications. Z#2 examined R#1 the following day and ordered the medications.
   
   
   Nurses Notes of 5/13/00 reveal "Tylenol liq given P.O.for pain" with no evidence of a physician's order for Tylenol.
   
   
   The family had R#1 transferred to another facility on 5/22/00.
   
   
   No evidence R#1 received ten medications from 5/10/00 to 5/17/00, and no evidence that R#1 received Vit C twice a day as ordered, and evidence that R#1 received a dose of Tylenol liq without a physician's order.