HospitalInspections.org

Based on review of hospital policies/procedures, medical records, staff and patient interviews, it was determined the hospital failed to demonstrate the informed consent provided to the individual patient, for 1 of 1 obstetric patients was signed by the physician confirming discussion with the patient (Patient #26).

Findings include:

The hospital policy titled Informed Consent (last reviewed 08/09) requires: "...It shall be the responsibility of the physician/licensed independent practitioner to secure the patient's/legal agents's/surrogate's informed consent prior to the initiation of the proposed procedures and or therapies. The explanation should include:...Potential benefits and risks, Potential problems related to recuperation...likelihood of success...possible results of non-treatment...any significant alternative therapies...In an emergency situation where the patient is unable to give consent and no legal agent or 'statutory surrogate' is available, consent to needed treatment may be implied...An emergency situation is one where the patient requires immediate care, and there is danger to life or health if the care is delayed...."

The hospital policy titled Informed Consent/Guideline (last reviewed 08/09) requires: "...Physician/licensed independent practitioner will discuss risks, benefits, complications and alternative methods of treatment, prior to certifying with his/her signature. The witness signs the consent form after validating the physician/licensed independent practitioner has discussed the content of the consent form...."

The Informed Consent for Childbirth and Anesthesia includes: "...My physician/CNM (certified nurse midwife) has explained the childbirth process, treatment goals, reasonable alternatives, the risks involved, the possible consequences and the possibility of complications to me...I consent to the performance of any other procedure(s) in addition to, or different from those now contemplated whether or not arising from unforeseen conditions...."

The Consent requires the delivering physician/CNM to mark 1 of 2 boxes identifying the practitioner as the "Primary Obstetrician/CNM" or the "Covering Obstetrician/CNM." The physician's "Primary Obstetrician/CNM" box certifies: "...I have personally explained the procedure of childbirth, treatment goals, reasonable alternatives, risks involved...possibility of complications to the patient or her authorized agent...." The physician's "Covering Obstetrician/CNM" box certifies: "...The patient has attested that per primary obstetrician...has explained procedure of childbirth, treatment goals, reasonable alternatives...risks involved...possibilities of complications to the patient. I have discussed the immediate delivery plan with this patient...."

The hospital policy titled Labor Patient, Care of (last reviewed 04/12) requires: "...Direct Admit/Induction...Have patient complete and sign...Informed consents: for 'Labor and delivery care with possible cesarean section'...The nurse may witness the signature and the provider will discuss the risks and benefits...and document accordingly. The primary or covering obstetrician will check the appropriate box and then date/time and sign the consent...."

The following was determined, according to the medical record:

Patient #26, gravida 4 now para 4, presented in active labor (5 cm dilated) on 05/01/12 at 1630. She signed a consent for "labor delivery, cesarean section if indicated" at 1700. The on-call obstetrician gave a verbal order to admit at 1758. The anesthesiologist placed an epidural block at 2000. The on-call physician documented a note on 05/02/12 at 0020, indicating the patient had no medical history. She delivered vaginally at 0047.

There was no physician/CNM signature on the consent.

Patient #26 confirmed during an interview conducted on 05/03/12, that she signed the consent on admission, however, stated that the physician did not discuss the risks or possible complications of labor/delivery or cesarean section at any time prior to her signature or the delivery.

Based on review of policies, procedures, observations in the emergency department (ED) and staff interview, it was determined the administrator failed failed to ensure the privacy for 10 of 10 current ED hallway patients.

Findings include:
The hospital policy titled Patients Rights and Responsibilities required: "...You have the right to reasonable privacy. The hospital, your doctor, and other (sic) caring for you will protect your privacy appropriately...."

Tours of the ED were conducted on 05/02/12 and 05/03/12.

The ED Director, during an interview on 05/02/12 at 0830 hours, explained that the ED has privacy curtains for patients placed in the hall.

A tour of the ED was conducted with the ED Director on 05/02/12 at 0845 hours. The privacy curtains were observed in a storage area in hallway A.

At 0845, three patients were observed in hallway A of the ED. None of the patients in hallway A had portable privacy curtains around the gurneys.

A second tour of the ED was conducted on 05/03/12 at 1400 hours with the Compliance Director.

Seven patients were observed in the hallway on gurneys. None of the 7 patients in hallway A had portable curtains for privacy around the gurneys. Fire department personnel and police department personnel were observed in hallway A during the tour.

The Director of Compliance confirmed the observations on 05/03/12.