COLUMBIA, SC — The incidents that led federal officials this month to threaten to pull Medicare coverage at Palmetto Health Richland involved improper administration of drugs, overuse of restraints and incomplete documentation in the case of a 78-year-old patient.
The Centers for Medicare and Medicaid Services investigated the hospital after a complaint by a member of the patient’s family. The Columbia hospital has submitted documents indicating its solutions to the problems, including improved coaching and education of its employees. The federal agency has staffers at the hospital this week to decide whether those solutions are sufficient.
“While no patient was harmed as a result of the identified deficiencies, we are using this learning opportunity to help ensure we continue to provide the highest quality care to our patients and their families,” the hospital said in a statement.
Medicare officials investigate many alleged violations annually and often find violations, but in the past two years only two facilities nationally have lost Medicare reimbursement coverage by failing to fix problems.
The State filed a Freedom of Information Act request for the investigative document in the Palmetto Health Richland case. The 34-page report deals with a woman admitted to the emergency room with pneumonia on May 7.
Physician notes said the family had “expressed multiple concerns” about the patient’s care, but none of those complaints were logged in the hospital’s grievance and complaint logs — one of several failures to follow procedure noted in the report.
On May 16, a physician wrote a order to restrain the patient because she was trying to climb out of the bed. The order called for a Posey vest, which constrains the torso. The staff administered a Posey vest and wrist restraints. The wrist restraints weren’t called for in the order.
On May 21, the patient complained of chest pains near the end of one nursing shift and a dose of nitroglycerin was requested from the pharmacy. Early in the next shift, the patient’s son complained that nothing had been done about his mother’s condition. The patient’s primary nurse picked up the patient’s nitroglycerin prescription and went to her room.
According to the reports by the nurses in the room, the patient’s son yelled at the nurses and tried to take the bottle from the primary nurse as she scanned the patient’s ID and the medication bottle label. Then the nurse poured the contents of the bottle in the patient’s mouth, later saying she thought the bottle held one dose.
The bottle held 25 tablets. The nurse realized the mistake and began to sweep the pills out of the patient’s mouth with her hand, but the son pushed her aside and began removing the pills himself.
The nurse later checked to make sure only one pill was in the patient’s mouth, according to the report. A physician was called to the room, and the patient was transferred to the cardiac unit. The report provides no more details on the patient from that point.
The report cited the hospital for several violations in the nitroglycerine incident, including not educating the primary nurse on the proper dosage. The report also noted the failure of the nurse, nurse manager and physician to immediately or fully document what had happened.