| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 531311 | (X3) Date Survey Completed 11/17/2011 |
| Name of Provider or Supplier Crook County Hospital | Street Address, City, State 713 Oak Street, Sundance, 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) |
| C0277 | PATIENT CARE POLICIES CFR(s): 485.635(a)(3)(v) [The policies include the following:] procedures for reporting adverse drug reactions and errors in the administration of drugs. This STANDARD is not met as evidenced by: Based on medical record review, staff interview, review of policies and procedures, and review of incident reports, the facility failed to ensure medication errors were identified and reported for 7 of 22 sample patients (#2, #4, #9, #12, #14, #15, #18). The findings were: According to the facility's policy and procedure, "Medication Errors," last revised 9/9/08, the definition of an error included "Omission of medication." Further review of this policy and procedure showed staff were to report any errors immediately to the physician and to the CNO and pharmacy manager within 24 hours. In addition, staff were to document the error in the patient's medical record and complete an incident report. Failure to follow this policy and procedure was identified as follows: a. Refer to C297 for detailed evidence related to medication errors for patients #2, #4, #9, #12, #14, #15, #18. b. Review of the incident reports with the CNO on 11/17/11 at 9:25 AM showed only two medication errors had been reported for acute care since 1/1/11. The CNO confirmed that the medication errors identified by the survey team had not been identified by the previous CNO although medication errors was one of the QAPI indicators being tracked for nursing services. |