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Based on review of personnel files, job description, emergency department schedule, Emergency Medical Services Personnel (EMSP) Rules and Regulations, and interviews, it was determined the facility failed to have a policy in accordance with state law that require EMSP be granted individual privileges approved by the medical staff. Failure of the medical staff to approve individual privileges did not ensure complaince with state law for five of five Paramedics, on the Emergency department schedule for June-July 2018, perform skills they were licensed to perform and in agreement with the hospital's governing body. The failed practice was likely to affect all patients who were treated in the Emergency Department. Findings included:

A. On 07/26/18 at 8:30 AM a copy of the Emergency Services Department schedule for June - July 2018 was requested. A total of five names were listed as "Medic" and identified as EMSP (Paramedics) by the Quality Manager. The Administrator/Director of Nursing and Quality Manager stated by interview on 07/26/18 at 10:02 AM that they had only Paramedic EMSP and they were not individually privileged by the medical staff; the job description was approved and the Human Resources department verified each license individually.
B. At 11:35 AM on 07/26/18 a Job description for Paramedics was presented by the Quality Manager. The job description included an overview statement that the Paramedic will assist the nursing and physician staff in providing patient care in the emergency room setting and the rapid assessment team. Duties and responsibilities to be performed in a manner consistent with the facility mission values and facility standards.
C. Review on 07/27/18 with the Administrator and Quality Manager of the Arkansas State Board of Health, Section of Emergency Medical Services, Rules and Regulations pertaining to Emergency Medical Services, Section X, Hospital Staffing, dated 03/14/18 showed that in order for an Arkansas Licensed EMSP to perform skills for which they are licensed within a hospital, the EMSP must ensure the hospital medical staff approve the privileges granted to the individual EMSP with the concurrence of the hospital's governing body. Specific policies governing the supervision and the procedures to be performed by the EMSP must be developed by the hospital medical staff and also approved by the hospitals' governing body. A roster with the delineation of privileges shall be maintained and readily available.
D. Personnel files of six emergency services staff, including two Paramedics, were reviewed on 07/27/18 at 9:00 AM with Human Resources Manager #1. There was no evidence of medical staff individual approval of privileges for Paramedics provided. The Administrator/Director of Nursing confirmed at the time of personnel file review that Paramedics are not individually privileged.



Based on clinical record review and interview, it was determined the facility failed to have a policy to assure patient consent for treatment was obtained at each hospital presentation for treatment. The failed practice did not allow individuals the opportunity to give consent prior to treatment and affected 2 (#1 and #2) of 20 (#1 - #20) clinical records reviewed, and was likely to affect any patient who presented to the facility for treatment. Findings included:

A. Clinical record review on 07/26-07/27/18 showed the consent form used by the facility was an annual agreement for services that granted agreement for services to be performed by a facility physician or non-physician provider. This consent was not signed at each presentation for services or treatment for 2 (#1 and #2) of 20 (#1-#20) clinical records reviewed. Findings follow:
1) Patient #1 was admitted 07/24/18. The most recent consent to treat was signed on 07/14/18 at 11:10 AM.
2) Patient # 2 was admitted on 07/23/18. The most recent consent to treat was signed on 06/11/18 at 10:53 AM.
B. The lack of consent for Patients #1 and #2 above was confirmed at the time of clinical record review on 07/26/18.
C. Review of the document "Physician and Hospital Services Agreement" identified by Medical Records Manager #1 as the consent for treatment showed "I consent to the services that may be performed by a physician or non-physician provider or facility. I understand I can withdraw this consent at any time. This consent and agreement applies to any provider service I may obtain from providers at a clinic or physician's office and also to any hospital services I obtain at a hospital or hospital based clinic location.
D. In an interview with the Administrator and the Quality Manger on 07/27/18 it was confirmed that a consent to treat was not required with each presentation for treatment and that the form and their practice is for the consent to treat to be signed on an annual basis.