Hospital Cited for deficient wound care of disabled children, and pharmacy cited for repeated use of expired medications

Cumberland Hospital was cited by the Centers for Medicare and Medicaid Services (CMS) for several deficiencies following an unannounced complaint investigation survey, including nursing services and pharmacy management and administration. CMS reviewed the records of two disabled children who had been patients at the facility. Patient #1, a 9-year-old girl with Spinal Bifida, seizure disorder, and loss of hearing and vision, used crutches and an ankle and foot orthodic (AFO) for mobility. CMS noted:
The physician admission orders on 4/14/11 noted the skin of Patient #1 was to be checked daily. The nursing care plan … did not include skin assessments or assessment of the proper placement of Patient #1’s AFO.
CMS found that during the patient’s stay from April to November 2011, skin assessments were not completed and tracked as required. The patient’s medical records go on to document wound care for abrasions on both the patient’s left and right great toes from July to September. The patient’s AFO’s were adjusted by a Physical Therapist in September. CMS also reviewed the case of a 14-year-old patient with diagnoses of cerebral palsy and organic affective disorder, who used a wheelchair for mobility and wore an AFO. CMS found, “There is no documentation of Patient #14’s AFO being assessed for correct placement or of a weekly or monthly skin assessment by the RN.” The patient was also ordered by a physician to be repositioned every two hours at night, but nursing staff instead documented “Patient #14 turning and repositioning self.” In its survey, CMS also found that the hospital failed to ensure that the Pharmacy Department stored or dispensed medications in a safe and appropriate manner. The hospital’s emergency drug kit was found to contain a broken vial of furosomide, with “broken glass spread around the individual compartments holding the medications.” In the medication room it was found that “narcotic counts were not being done every shift,” and the facility had missed 5 out of 42 required counts in the month of October, and 4 out of 90 counts in September. Patients’ medication drawers were found to contain expired and unlabeled medications, as were emergency crash carts on two units. The facility’s pharmacist showed inspectors a Board of Pharmacy inspection from April 2012, in which the facility “was cited deficiencies for repackaging drugs that were ‘labeled with an expiration date exceeding the expiration date of the stock bottle.'” Although the facility had conducted internal audits each month since that inspection, these audits had not found any expired medication. As a result of CMS’ findings, the facility was required to submit a plan of correction.