Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391
Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 530033 (X3) Date Survey Completed 10/23/2013
Name of Provider or Supplier Mountain View Regional Hospital Street Address, City, State 6550 East 2nd Street, Casper, WY
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
A0405 ADMINISTRATION OF DRUGS
CFR(s): 482.23(c)(1), (c)(1)(i) & (c)(2)

(1) Drugs and biologicals must be prepared and administered in accordance with Federal and State laws, the orders of the practitioner or practitioners responsible for the patient's care as specified under §482.12(c), and accepted standards of practice. (i) Drugs and biologicals may be prepared and administered on the orders of other practitioners not specified under §482.12(c) only if such practitioners are acting in accordance with State law, including scope of practice laws, hospital policies, and medical staff bylaws, rules, and regulations. (2) All drugs and biologicals must be administered by, or under supervision of, nursing or other personnel in accordance with Federal and State laws and regulations, including applicable licensing requirements, and in accordance with the approved medical staff policies and procedures.


This STANDARD is not met as evidenced by:
Based on staff interview, medical record review, and review of the nursing facility death records, the hospital failed to ensure PRN antipsychotic medications administered were necessary for 1 of 7 sample patients (#3). The findings were: Review of the updated history and physical performed on 5/21/13 for patient #3 showed the patient's mental status was normal for age and situation. Review of the pre-operative nursing assessment showed the patient had no memory deficits, responded appropriately, and followed directions. Review of the 5/22/13 nursing notes timed at 8 AM showed the patient's speech pattern, behaviors, and mood were all appropriate. Review of the 5/23/13 nursing assessment timed at 8:45 AM showed the patient's speech pattern and mood were appropriate and his/her behaviors were cooperative. Review of the 5/23/13 nursing assessment timed at 8 PM showed the patient was alert and oriented, his/her speech was clear, and his/her behaviors were appropriate. Review of the 5/24/13 nursing assessment timed at 7 AM, the 5/24/13 nursing assessment timed at 7 PM, and the 5/25/13 nursing assessment timed at 6:52 AM showed the patient continued to be appropriate and cooperative with mood and behaviors. Review of the post anesthesia care unit (PACU) notes showed on 5/25/13 at 8:13 PM, after the second surgical procedure (unplanned), the patient did become agitated and required antipsychotic medication in PACU. However, according to the 5/26/13 nursing assessment timed at 6:26 AM, the patient was cooperative with care, his/her speech pattern was appropriate and his/her mood was appropriate. Review showed no evidence the patient continued to be agitated or confused as s/he was immediately post-operatively. Review of the 5/26/13 nursing assessment timed at 6:59 PM, the 5/27/13 nursing assessment timed at 5:03 AM, 7 AM, and again at 7:26 PM, all showed the patient was cooperative and appropriate with mood and behaviors but was somewhat drowsy. Review of the 5/28/13 nursing assessment timed at 7:45 AM showed the patient's mood and behaviors were appropriate. However, review of the MAR showed the patient was administered haldol, an antipsychotic medication used for psychosis, on 5/28/13 at 7:02 AM, the day of discharge to a nursing home. Review of the entire medical record showed no rationale for the necessity of the medication haldol. In addition, interview with the DON on 10/23/13 at 10:20 AM revealed he did not know why the haldol was given. He verified there was no evident rationale for the antypsychotic medication that was administered to the patient at that time. Review of the nursing facility death record showed the patient was lethargic but responsive upon admission. According to the nursing facility nursing notes, the patient was found dead at 4:20 AM on the morning of 5/29/13, less than 24 hours after being transferred from the hospital.