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This standard is not met as evidenced by:

Based on 1 of 1 interview and 1 of 1 record review by surveyor #29972, the hospital failed to have a system in place that ensures patients are aware of the right to have family and/or MD contacted shortly after admission to the hospital.

Record review of Hospital's Patient Rights on 7/12/11 at 9:00 am, confirmed the following: "family and MD notified" of admission statement is not listed on Patient Rights forms given to the patient upon admission to the hospital. This is confirmed in interview with staff F on 7//12/11 at 9:40 am.

This standard is not met as evidenced by:

Based on 1 of 1 interview and 1 of 1 observation by surveyor #29972, the hospital failed to ensure the confidentiality of all medical records at the offsite medical records storage location.

Finding include:

During a tour of the offsite medical records storage location by surveyor #29972 on 7/13/11 at 8:50 am, observed a large warehouse of multiple staff members handling, preparing, scanning and sorting medical documents. Per interview with staff O ( Off site Sales Manager) there are approximately 30-50 employees handling medical records at any given time. Staff O stated the facility handles medical records from multiple health care facilities and the records are sorted by numbers not by facility. Surveyor #29972 asked staff O if any of the employees receive any HIPAA training or sign a HIPAA agreement to confidentiality and Staff O stated "No", employees only sign a Confidentiality Agreement upon applying for employment.

Per review of Hospital's Electronic Record Security Policy dated 8/2010, by surveyor #29972 on 7/14/11 at 12:30 pm, the hospital requires the following: "All employees must sign the HIPAA agreement to confidentiality".

Based on record review, interview and policy & procedure review the hospital failed to ensure all medical record entries were dated and or timed and authenticated in 23 out of 34 medical records reviewed. Operative Reports for pt's. #1, 5, 6, 7, 8, 9, 11, 12, 13, 15, 16, 19, 20, 21, 22, 23, 28,and 36 with no date and time by the physicians signature. History and Physical for pt's. #5, 20 with no date and time by physician signatureand #31 with no physician signature. Consent for surgery for pt. #23 with no pt. signature. Discharge summary for pt. #1 (not signed) # 5, 9, 11, 12, 13, 15, 16 (not signed), 19 (not signed) 20, 22 and 23 with no date or time by the physician signature. Transfer summary for pt. #4 with no date or time by the physician signature. Telephone orders for pt's #6, 8, 9, 10, 11, 12, 14, and 16 with late signatures. MD order not signed for pt. #15.

Findings include:

On 7-13-2011 at 8:20 AM a review of medical record for pt. #1 revealed a discharge summary dated 6/29/2011 with no physician signature, an Operative Report (OR) dated 6/6/2011 with no time or date by the physician signature.

On 7-13-2011 at 1:45 PM a review of medical record for pt. #21 revealed an OR dated 8/5/2010 with no time by the physician signature.

On 7-13-2011 at 2:52 PM a review of medical record for pt. #22 revealed a discharge summary dated 9/14/2010 with no date or time by the physician signature, an OR dated 8/23/2010 with no time or date by the physician signature.

On 7-13-2011 at 3:09 PM a review of medical record for pt. #23 revealed a discharge summary dated 2/15/2011 with no date or time by the physician signature, an OR dated 2/1/2011 with no time or date by the physician signature and a consent for surgery dated 2/1/2011 with no pt. signature and no date or time next to the physicians signature.

On 7-14-2011 at 9:45 AM a review of medical record for pt. #28 revealed a OR dated 7/11/2011 with no time or date by the physician signature.

On 7-14-2011 at 10:45 AM a review of medical record for pt. #31 revealed a surgery date of 7/12/2011 and a History & Physical dated 7/1/2011 with no physician signature.

On 7-14-2011 at 11:30 AM a review of medical record for pt. #36 revealed a OR dated 7/11/2011 with no time or date by the physician signature.
The above findings were confirmed with Director of Inpatient Services G on 7/14/2011 at 10:40 AM.


29972


Findings:

Pt #4's medical record review by surveyor #29972 on 7/13/2011 at 9:40 am revealed the following: Transfer summary dated 7/8/201 is not authenticated by MD with time and date. This is confirmed in interview with with RN G on 7/14/2011 at 10:50 am.

Pt #5's medical record review by surveyor #29972 on 7/13/2011 at 11:20 am revealed the following: Discharge summary dated 7/26/2011 is not authenticated by MD with time and date signed. History and Physical dated 7/19/2011 is not authenticated by MD with time and date signed. Operative report dated 7/23/2011 is not authenticated by MD with time and date signed. This is confirmed in interview with RN G on 7/14/2011 at 10:50 am.

Pt #6's medical record review by surveyor #29972 on 7/13/2011 3:15 pm revealed the following: Operative report dated 2/7/2011 is not authenticated by MD with time and date signed. 2 Telephone orders dated 2/8/2011 not authenticated by MD until 2/14/2011. Medical records policy reviewed by surveyor #29972 on 7/14 at 10:00 revealed telephone/verbal orders will be countersigned by the responsible staff physician within 48 hours. This is confirmed in interview with RN G on 7/14/2011 at 10:50 am.

Pt #7's medical record review by surveyor #29972 on 7/13/2011 at 3:30pm revealed the following: Operative report dated 5/4/2011 is not authenticated by MD with time and date signed. This is confirmed in interview with RN G on 7/14/2011 at 10:50 am.

Pt #8's medical record review by surveyor #29972 on 7/14/2011 at 9:15 am revealed the following: Operative report dated 5/11/2011 is not authenticated by MD with time and date signed. Telephone order dated 5/12/11 not authenticated by MD until 5/17/11. Medical records policy reviewed by surveyor #29972 on 7/14 at 10:00 revealed telephone/verbal orders will be countersigned by the responsible staff physician within 48 hours. This is confirmed in interview with RN G on 7/14/2011 at 10:50 am.

Pt #9's medical record review by surveyor #29972 on 7/14/2011 at 9:30 am revealed the following:
Operative report dated 4/26/2011 is not authenticated by MD with time and date signed. Discharge summary dated 4/28/2011 is not authenticated by MD with time and date signed. Telephone order dated 4/26/2011 not authenticated by MD until 5/18/11, telephone order dated 4/28/11 not authenticated by MD until 5/10/11. Medical records policy reviewed by surveyor #29972 on 7/14 at 10:00 revealed telephone/verbal orders will be countersigned by the responsible staff physician within 48 hours. This is confirmed in interview with RN G on 7/14/2011 at 10:50 am.

Pt #10's medical record review by surveyor #29972 on 7/14/11 at 9:45 am revealed the following: 3 Telephone orders dated 4/28/11 not authenticated until 5/3/11, Medical records policy reviewed by surveyor #29972 on 7/14 at 10:00 revealed telephone/verbal orders will be countersigned by the responsible staff physician within 48 hours. This is confirmed in interview with RN G on 7/14/11 at 10:50 am.

Pt #11's medical record review by surveyor #29972 on 7/14/2011 at 10:00 am revealed the following: Operative report dated 5/23/2011 is not authenticated by MD with time and date signed. Discharge summary dated 5/26/2011 is not authenticated by MD with time and date signed. Telephone order dated 5/25/11 not authenticated by MD until 6/2/11. Medical records policy reviewed by surveyor #29972 on 7/14 at 10:00 revealed telephone/verbal orders will be countersigned by the responsible staff physician within 48 hours. This is confirmed in interview with RN G on 7/14/2011 at 10:50 am.

Pt #12's medical record review by surveyor #29972 on 7/14/2011 at 10:15 am revealed the following: Operative report dated 5/24/2011 is not authenticated by MD with time and date signed. Discharge summary dated 6/2/2011 is not authenticated by MD with time and date signed. Telephone order dated 5/27/11 not authenticated by MD until 6/7/11. Medical records policy reviewed by surveyor #29972 on 7/14 at 10:00 revealed telephone/verbal orders will be countersigned by the responsible staff physician within 48 hours. This is confirmed in interview with RN G on 7/14/2011 at 10:50 am.

Pt #13's medical record review by surveyor #29972 on 7/14/2011 at 10:30 am revealed the following: Operative report dated 5/31/2011 is not authenticated by MD with time and date signed. Discharge summary dated 6/4/2011 not authenticated by MD with time and date signed. This is confirmed in interview with RN G on 7/14/2011 at 10:50 am.

Pt #14's medical record review by surveyor #29972 on 7/14/11 at 10:35 am revealed the following: Telephone order dated 6/9/11 not authenticated by MD with signature, time, or date. Telephone order dated 6/10/11 not authenticated by MD until 6/21/11. Medical records policy reviewed by surveyor #29972 on 7/14 at 10:00 revealed telephone/verbal orders will be countersigned by the responsible staff physician within 48 hours. This is confirmed in interview with RN G on 7/14/11 at 10:50 am.

Pt #15's medical record review by surveyor #29972 on 7/14/2011 at 10:40 am revealed the following: Operative report dated 6/14/2011 is not authenticated by MD with time and date signed. Discharge Summary dated 6/17/2011 is not authenticated by MD with time and date signed. MD order dated 6/15/11 not signed, timed or dated This is confirmed in interview with RN G on 7/14/2011 at 10:50 am.

Pt #16's medical record review by surveyor #29972 on 7/14/2011 at 10:45 am revealed the following: Operative report dated 6/21/2011 is not authenticated by MD with time and date signed. Discharge summary dated 6/24/2011 is not signed, dated, or timed by MD. Telephone order dated 6/24/11was not authenticated by MD with signature, time, or date. Medical records policy reviewed by surveyor #29972 on 7/14 at 10:00 revealed telephone/verbal orders will be countersigned by the responsible staff physician within 48 hours. This is confirmed in interview with RN G on 7/14/2011 at 10:50 am.

Pt #17's medical record review by surveyor #29972 on 7/14/2011 at 11:00 am revealed the following: Operative report dated 6/23/2011 is not authenticated by MD with time and date signed. This is confirmed in interview with RN G on 7/14/2011 at 12:30pm.

Pt #18's medical record by surveyor #29972 on 7/14/2011 at 11:15 am revealed the following: Operative report not authenticated by MD with date and time signed. This is confirmed in interview with RN G on 7/14/2011 at 12:30pm.

Pt #19's medical record by surveyor #29972 on 7/14/2011 at 11:25 am revealed the following: Operative report dated 7/5/2011 is not authenticated by MD with time and date signed. Discharge summary dated 7/8/2011 is not signed, dated, or timed by MD. This is confirmed in interview with RN G on 7/14/2011 at 12:30pm.

Pt #20's medical record by surveyor #29972 on 7/14/11 at 11:35 am revealed the following: Operative report dated 7/26/2011 is not authenticated by MD with time and date signed. Discharge summary is not authenticated by MD with date and time signed. History and Physical dated 7/21/2011 is not authenticated by MD with date and time signed. This is confirmed in interview with RN G on 7/14/2011 at 12:30pm.

A standard Recertification Survey for Life Safety Code compliance was conducted by the Wisconsin Division of Quality Assurance between 07/11/2011 through 07/13/2011. The Orthopaedic Hospital of Wisconsin was found to be NOT in compliance with the following applicable regulations for hospital participation in Medicare-Medicaid:

42 CFR 482.41 Condition of Participation: Physical Environment was NOT MET
42 CFR 482.41(a) Standard: Buildings was NOT MET
42 CFR 482.41(b) Standard: Safety from Fire was NOT MET
42 CFR 482.41(c), (c)(2), (c)(3) & (c)(4) Standards: Facilities was NOT MET
NFPA 101- Life Safety Code was NOT MET.

The Orthopaedic Hospital of Wisconsin is a 3-story structure with a Penthouse built and occupied in November 2009, with Type II (111) fire-resistive construction. All portions of the hospital facility were sprinklered. The hospital facility had an emergency generator that provided power to the emergency loads. The facility contained 2 patient care wings at 3rd Floor and 7 smoke compartments.

Also surveyed was an off-site Medical Records Storage Site at 4066 N. Port Washington Road, Milwaukee, WI 53212. This 1-story structure was constructed in 1950 with Type II (000) fire-resistive construction. The facility was fully-sprinklered. The storage site was operated by OnCourse Information Services, Inc. Brian Sewart, CEO and Jim Peterson, Sales Mgr. of OnCourse stated that several large healthcare systems in the Milwaukee Metropolitan area keep their Medical Records at this location. All of these other health care organizations are also in violation of protecting their patient Medical Records at this site.

Orthopaedic Hospital of Wisconsin is licensed for 30 beds, with a census of 5 inpatients and 123 outpatients = 128 total patients at the time of the survey entrance on 07/11/2011. The facility operated several outpatient functions in the hospital on those days. The hospital facility was surveyed under the 2000 Life Safety Code, Chapter 18 (new) for a Health Care Occupancy and Chapter 39 (existing) at the Satellite Medical Records Facility. Thirty (30) federal deficiencies of the Life Safety Code were cited.
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Based on observation and interview, the medical records storage facility did not provide a sprinkler system that was installed according to NFPA 13 as required by the Life Safety Code, section 9.7.1.1. The Wisconsin Department of Health Services and Centers for Medicare Services have not identified any exceptions to permit non-compliance with NFPA 13 in an existing healthcare facility or facility used to hold the medical record of patients. The AHJ considers any non-compliance a distinct hazard to life in existing facilities, since patient's medical records are essential to their care, they rely on a highly reliable sprinkler system to protect them. This is consistent with NFPA 13 (1999 edition) 1-3, which notes that while NFPA 13 is not normally applied to existing facilities, the AHJ can apply it in cases where the AHJ feels there is a distinct hazard to life or property including patient medical record. The facility did not provide a sprinkler system with unobstructed water distribution. This deficiency occurred in 1 of the 6 smoke compartments of the hospital and 1 of 2 smoke compartments of the satellite facility, and had the potential to affect 20 of the 30 patients that the hospital facility was licensed to serve, as well as an undetermined number of staff and visitors at both hospital and satellite facility.

FINDINGS INCLUDE:
On 07/13/2011 at 9:15 am surveyor #18107 observed in the 1SCS smoke compartment on the First floor in the Medical Record Storage Room, that the discharge of sprinkler water was prevented from reaching an unprotected area on the other side of the obstructing items. The obstruction included A 200' x 100' layer of plastic visqueen that was placed below the sprinkler system and would prevent discharge water from reaching the protected space and medical record files. The visqueen had been placed in this location because of a leaking roof condition. This observed situation was not compliant with NFPA 13 (1999 edition), 5-6.5. The condition was confirmed at the time of discovery by a concurrent observation and interview with hospital staff F (Dir. Of Rehab. Services), staff H (Dir. Of Diagnostic Services) and staff Q (Bldg. Services Coord.) and owners and operators of the Medical Record Storage Facility called OnCourse Information Services, Inc.

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Based on observation, staff interviews and review of maintenance records, the facility did not provide a building that was designed and maintained in accordance with Federal, State and local laws, regulations and guidelines. The facility did not have a building that complied with state regulations that were in effect when the space was built. This deficiency occurred in 1 of the 6 smoke compartments, and had the potential to affect 28 of the 30 patients that the facility was licensed to serve, as well as an undetermined number of staff and visitors.

FINDINGS INCLUDE:
On 07/11/2011 at 9:50 am surveyor #18107 observed in the 1SCN smoke compartment on the First floor in the 1524-General Storage/ Supplies Room, that during a review of facility documents the facility failed to install a system that was designed and maintained in accordance with federal, state and local laws that were in effect at the time of construction. The space was not provided with compliant ventilation per the 2006 Building Code and 2006 Health Code enforced at the time of plan review and constructed from 2008 through 2009. It was observed that this storage room was missing a 'thermostat' to control the temperature of this room since the room was storing 'fluids' used in human consumption. This observed situation was not compliant with 42 CFR 482.41(c). The condition was confirmed at the time of discovery by a concurrent observation and interview with staff B (Facilities Director), staff C (Maintenance Mechanic), staff F (Dir. Of Rehab. Services), and staff H (Dir. Of Diagnostic Services).

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Based on observation, staff interviews and review of maintenance records, the facility did not maintain supplies and equipment to ensure an acceptable level of safety and quality. The facility did not have and properly stored emergency supplies. This deficiency occurred in 2 of the 6 smoke compartments, and had the potential to affect 12 of the 30 inpatients that the facility was licensed to serve at those locations, as well as an undetermined number of staff and visitors.

FINDINGS INCLUDE:
1. On 07/11/2011 at 11:07 am surveyor #18107 observed in the 3SCS smoke compartment on the Third floor in the 3155-Pharmacy Clean Room, that supplies were not stored at least 4 inches above the finished floor to ensure the safety of the stored supplies, such as protection against damage, contamination or deterioration. Two capsules and one vial tube were observed on floor under the laminar flow hood. The stored materials on the floor may endanger patients (safe storage practices). This observed situation was not compliant with 42 CFR 482.41(c)(2). The condition was confirmed at the time of discovery by a concurrent observation and interview with staff B (Facilities Director), staff C (Maintenance Mechanic), staff H (Dir. Of Diagnostic Services), and staff E (Inpatient Manager).

2. On 07/12/2011 at 3:29 pm surveyor #18107 observed in the 2SCE smoke compartment on the Second floor in the 2418-Equipment Alcove off Corridor 2415, that supplies were not stored to ensure the safety of the stored supplies, such as protection against damage, contamination, or deterioration. One 0.9% Sodium Chloride bag was laying on floor next to supply cart. This bag could be used in a patient treatment or surgery case and storage practices might endanger patients like; blocking passageways and safe storage practices for sodium chloride solutions, etc. This observed situation was not compliant with 42 CFR 482.41(c)(2). The condition was confirmed at the time of discovery by a concurrent observation and interview with staff B (Facilities Director), staff C (Maintenance Mechanic) and staff Q (Bldg. Services Coord.).

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Based on observation, staff interviews and review of maintenance records, the facility did not construct, install and maintain a proper ventilation and temperature control system in pharmaceutical, food preparation, and other appropriate areas. The facility did not have proper preventive maintenance of facility lighting. This deficiency occurred in 1 of the 6 smoke compartments, and had the potential to affect 5 of the 11 outpatients that the facility was licensed to serve this day in this smoke compartment, as well as an undetermined number of staff and visitors.

FINDINGS INCLUDE:
On 07/12/2011 at 2:35 pm surveyor #18107 observed in the 1SCW smoke compartment on the First floor in the 1123-Food Prep Servery of Food Service Suite, that the space was not constructed and maintained to ensure proper lighting. A light was burnt-out within the grease hood, diminishing the light level required for the hot food cooking area over the gas burners. This observed situation was not compliant with 42 CFR 482.41(c)(4). The condition was confirmed at the time of discovery by a concurrent observation and interview with staff M (Food & Nutritional Srvs.), staff L (Dir. of Food Service ) and staff C (Maintenance Mechanic).

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Based on observation, staff interviews and review of maintenance records, the facility did not construct, install and maintain a proper ventilation and temperature control system in pharmaceutical, food preparation, and other appropriate areas. The facility did not have CDC cleaning guidelines, and CDC separation guidelines. This deficiency occurred in all of the 6 smoke compartments, and had the potential to affect all of the 30 inpatients that the facility was licensed to serve, as well as an undetermined number of staff and visitors.

FINDINGS INCLUDE:
1. On 07/11/2011 at 9:45 am surveyor #18107 observed that visible accumulation of dirt and dust were present on the floor surface in this health care environment throughout the hospital from 1st through 3rd Floors in non-carpet areas. During the entire survey of the hospital the floor and baseboard surfaces were showing dust and dirt in room and area corners, under counter tops, under carts, in corridors, and many places where it would require someone to move a cart or reach under a counter to clean the floor to a basic minimum requirement for a health care facility. The housekeeping staff is an outside vendor called Clean Power, Inc. and the hospital is suppose to be cleaned every day. This observed situation was not compliant with 42 CFR 482.42(a). The condition was confirmed at the time of discovery by a concurrent observation and interview with staff B (Facilities Director), staff C (Maintenance Mechanic), staff F (Dir. Of Rehab. Services), and staff H (Dir. Of Diagnostic Services).

2. On 07/11/2011 at 10:24 am surveyor #18107 observed in the 2SCW smoke compartment on the Second floor in the 2604-Stage 2 Recovery area at Nourishment Counter, that visible accumulation of dirt and dust were present on the food equipment surface in this health care environment. The microwave and ice machine surfaces were showing dust and dirt build-up. This observed situation was not compliant with 42 CFR 482.42(a). The condition was confirmed at the time of discovery by a concurrent observation and interview with staff B (Facilities Director), staff C (Maintenance Mechanic), staff H (Dir. Of Diagnostic Services), and staff G (Dir. Of Inpat. Services).

3. On 07/11/2011 at 10:51 am surveyor #18107 observed in the 3SCN smoke compartment on the Third floor in the 3214-Storage Room, that visible accumulation of dirt and dust were present on the floor surface in this health care environment throughout the hospital from first through third floors in non-carpet areas. The floor and baseboard surfaces were showing dust and dirt in room and area corners, and many places where it would require someone to move a cart or reach under a counter to clean the floor to a basic minimum requirement for a health care facility. This observed situation was not compliant with 42 CFR 482.42(a). The condition was confirmed at the time of discovery by a concurrent observation and interview with staff B (Facilities Director), staff C (Maintenance Mechanic), staff H (Dir. Of Diagnostic Services), and staff E (Inpatient Manager).

4. On 07/11/2011 at 10:52 am surveyor #18107 observed in the 3SCN smoke compartment on the Third floor in the 3213-Staff Toilet Room, that visible accumulation of dirt and dust were present on the HVAC supply grille surface. There was a visible accumulation of dirt and dust on the HVAC supply grille surface. This observed situation was not compliant with 42 CFR 482.42(a). The condition was confirmed at the time of discovery by a concurrent observation and interview with staff B (Facilities Director), staff C (Maintenance Mechanic), staff H (Dir. Of Diagnostic Services), and staff E (Inpatient Manager).

5. On 07/11/2011 at 10:59 am surveyor #18107 observed in the 3SCN smoke compartment on the Third floor in the 3174-Clean Workroom, that visible accumulation of dirt and dust were present on the floor surface in this health care environment throughout the hospital from first through third floors in non-carpet areas. The floor and baseboard surfaces were showing dust and dirt in room and area corners, and many places where it would require someone to move a cart or reach under a counter to clean the floor to a basic minimum requirement for a health care facility. This observed situation was not compliant with 42 CFR 482.42(a). The condition was confirmed at the time of discovery by a concurrent observation and interview with staff B (Facilities Director), staff C (Maintenance Mechanic), staff H (Dir. Of Diagnostic Services), and staff E (Inpatient Manager).

6. On 07/11/2011 at 11:01 am surveyor #18107 observed in the 3SCN smoke compartment on the Third floor in the 3172-Clean Storage Room, that visible accumulation of dirt and dust were present on the floor surface in this health care environment throughout the hospital from first through third floors in non-carpet areas. The floor and baseboard surfaces were showing dust and dirt in room and area corners, and many places where it would require someone to move a cart or reach under a counter to clean the floor to a basic minimum requirement for a health care facility. This observed situation was not compliant with 42 CFR 482.42(a). The condition was confirmed at the time of discovery by a concurrent observation and interview with staff B (Facilities Director), staff C (Maintenance Mechanic), staff H (Dir. Of Diagnostic Services), and staff E (Inpatient Manager).

7. On 07/11/2011 at 11:12 am surveyor #18107 observed in the 3SCS smoke compartment on the Third floor in the 3152-Housekeeping Closet, that visible accumulation of dirt and dust were present on the HVAC supply grille surface. There was a visible accumulation of dirt and dust on the HVAC supply grille surface. This observed situation was not compliant with 42 CFR 482.42(a). The condition was confirmed at the time of discovery by a concurrent observation and interview with staff B (Facilities Director), staff C (Maintenance Mechanic), staff H (Dir. Of Diagnostic Services), and staff E (Inpatient Manager).

8. On 07/11/2011 at 11:18 am surveyor #18107 observed in the 3SCS smoke compartment on the Third floor in the 3161-Clean Equipment Storage, that visible accumulation of dirt and dust were present on the floor surface in this health care environment throughout the hospital from first through third floors in non-carpet areas. The floor and baseboard surfaces were showing dust and dirt in room and area corners, and many places where it would require someone to move a cart or reach under a counter to clean the floor to a basic minimum requirement for a health care facility. This observed situation was not compliant with 42 CFR 482.42(a). The condition was confirmed at the time of discovery by a concurrent observation and interview with staff B (Facilities Director), staff C (Maintenance Mechanic), staff H (Dir. Of Diagnostic Services), and staff E (Inpatient Manager).

9. On 07/11/2011 at 11:21 am surveyor #18107 observed in the 3SCN smoke compartment on the Third floor in the 3106-Storage Room , that visible accumulation of dirt and dust were present on the floor surface in this health care environment throughout the hospital from first through third floors in non-carpet areas. The floor and baseboard surfaces were showing dust and dirt in room and area corners, and many places where it would require someone to move a cart or reach under a counter to clean the floor to a basic minimum requirement for a health care facility. This observed situation was not compliant with 42 CFR 482.42(a). The condition was confirmed at the time of discovery by a concurrent observation and interview with staff B (Facilities Director), staff C (Maintenance Mechanic), staff H (Dir. Of Diagnostic Services), and staff E (Inpatient Manager).

10. On 07/12/2011 at 2:37 pm surveyor #18107 observed in the 1SCW smoke compartment on the First floor in the 1123-Food Prep Servery of Food Service Suite, that visible accumulation of dirt and dust were present on the HVAC return grille surface next to the Kitchen hood. This observed situation was not compliant with 42 CFR 482.42(a). The condition was confirmed at the time of discovery by a concurrent observation and interview with staff M (Food & Nutritional Srvs.), staff L (Dir. of Food Service ) and staff C (Maintenance Mechanic).

11. On 07/12/2011 at 2:41 pm surveyor #18107 observed in the 1SCW smoke compartment on the First floor in the 1123-Freezer Entry of Food Service Suite, that visible accumulation of dirt and dust were present on the floor surface in this health care environment throughout the hospital from first through third floors in non-carpet areas. The floor and door threshold at the freezer door surfaces were showing food residue build-up over a period of days. This observed situation was not compliant with 42 CFR 482.42(a). The condition was confirmed at the time of discovery by a concurrent observation and interview with staff M (Food & Nutritional Srvs.), staff L (Dir. of Food Service ) and staff C (Maintenance Mechanic).

12. On 07/12/2011 at 3:23 pm surveyor #18107 observed in the 2SCE smoke compartment on the Second floor in the Central Sterile Reprocessing (CSR) Room, that clean and soiled areas were inter-mixed for storing medical items. Walls were damaged from movable carts in CSR. This observed situation was not compliant with 42 CFR 482.42(a). The condition was confirmed at the time of discovery by a concurrent observation and interview with staff B (Facilities Director), staff C (Maintenance Mechanic) and staff Q (Bldg. Services Coord.).

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26390

Findings include:

On 7-11-11 from 9:14 AM through 11:15 AM a tour of the hospital was conducted with Director of Inpatient Services(DIS) G. The following observations were made.
In Clean Storage room #1503 dirt, torn products and paper were noted under the storage racks. In the second floor pre-op area there were 3 breaks in the drywall leaving the surface uncleanable. In Soiled Utility room #2314 there were breaks in the walls, outside of the room the hallway had breaks in the drywall, and the vinyl base board was pulled away from the floor exposing the sub-floor leaving that area uncleanable. Room #2312, adjoins to the decontamination room, the pass-through window was left open. Dust and debris was noted on the floor and under the rolling storage racks. The Support Corridor had breaks in the drywall accross from room #2105. Clean storage room #2224 was noted to have a build up of dirt/dust on the shelving. The Post Anesthesia Care Unit had numeous breaks in the drywall in or near bays #4, 7, 8, 9, 10, and 11. Bay #5 contained a metal rolling cart with linens that was uncovered. Nutrition Center #2605 had an accumulation of dust and debri on top of the ice machine, microwave oven, back splash of counter top, inside drawers and cabinets, and floor. The ceiling vent was covered with dust.

In the Phase 2 area charting station, the cabinet for storing bags and supplies for surgical patients to take home contained 4 bags of Sodium Chloride that expired in 11/2010. General storage room #3225 was noted to have dirt, debris and packing material on the floor, and a dirty ceiling tile. Storage rooms #3214 and #3172 were noted to have dust covered ceiling vent, dust, debris and packing material on the floors and under rolling storage racks. In the pharmacy area the following was noted on the floor under "Edge Gard" hood: an unopended vial of Potassium Chloride, needle cap and 2 vial caps. Janitor room #3152 had cheerios, crackers, dust and debris on the floor. DIS G observed and confirmed the above findings during the tour.



On 7-12-2011 at 11:05 AM observation of Operating Rom #5 was made. The 2 air vents located on opposite walls located near the floor were noted to have blue dust on the vent covers. Surgical Technician (ST) U, ST V, Registered Nurse (RN) W, RN Y, Anesthesia Tech X and Anesthesiologist AA were all observed with no shoe covers.

On 7-12-2011 at 12:47 PM surgical trays were followed to the decontamination room with Director of Inpatient Services (DIS) G, and Surgical Tech (ST) U. The counter tops in the decontamination room were filled with surgical trays stacked on top of one another. Approximately 19 trays were waiting for processing. DIS G and ST U could not say how long the trays had been there. At approximately
1:05 pm 2 central sterile processing technicians returned from lunch to start processing surgical trays.

On 7-12-2011 at 1:55 PM a male visitor wearing surgical scrubs was observed talking on the phone and leaving the hospital walking towards the parking lot. The visitor walked back into the hospital then returned outside and walked to a car in the parking lot, opened the car and placed a bag inside. The visitor returned to the building, stated he was going into another surgery case and proceded to walk up the stairs to the surgery floor. Director of Rehab, F made the observation with surveyor and reported the observation to Director of Inpatient Services G.

On 7-12-2011 at 2:45 PM a review of the policy and procedure (P&P) titled Traffic/Surgical Attire was completed. The P&P states in part "Scrubs shall not leave hospital premises". "Restricted areas: scrub attire plus masks shall be worn" "Scrub attire shall consist of laundered scrub top, pants, long sleeved jacket, disposable shoe covers, and disposable head covers.""The OR Suites shall be considered restricted areas."
At 3:30 PM the above findings were confirmed with Director of Inpatient Services G, who explained they allow dedicated shoes however do not have a policy for such. The visitor leaving the hospital and contaminating scrubs was a vendor observing surgery cases.






29972



Findings include:

Observation by surveyor #29972 while touring the dietary department with Director of Food service(L) on 7/12/11 between 2:30 pm and 3:00 pm, revealed the following: Clean cleaning towels and clean linen napkins were stored uncovered on dry food storage cart underneath card board boxes, exposing clean items to possible dirt and debris contamination. Per interview with Director of Food Service(L), clean linen napkins are used to wrap silverware and placed on food tray for patient use. Surveyor #29972 also observed clean linen napkins uncovered in stainless steel container underneath the food prep sink next to Sanicloth container used for cleaning and a bottle of cleaning solution, allowing for clean linen napkins (patients may use to wipe off their mouth) to be contaminated with food debris and potentially hazardous chemicals.

The above findings were confirmd in interview by surveyor #29972 with the Director of Food Services(L) on 7/12/11 between 2:30pm and 3:00pm.

Based on record review, observation, interview, and Material Safety Data Sheet the hospital failed to provide surgical services in accordance with acceptable standards of practice for use of alcohol-based skin preparations in 34 of 34 medical records reviewed.

Findings include:
Review of the 2011 AORN Standard of Practice for prevention of fires when using alcohol based skin preperations revealed the following actions to follow peri-operatively-

Actions
1. Prevent pooling of skin prep solutions on or around the patient.
2. Remove prep-soaked linen and disposable prepping drapes before placing surgical drapes.
3. Allow skin prep agents to dry and fumes to dissipate before draping the patient and using an ignition source (eg, electrosurgical unit [ESU], laser).
4. Conduct skin prep " time out " to validate the prepping agent is dry before draping the patient.
5. Allow chemicals (eg, alcohol, collodion, tinctures) to dry thoroughly and vapors to dissipate before using an ignition source.
Review of MSDS sheet for ChloraPrep orange tinted revealed the following information.

HAZARDS IDENTIFICATION
This product consists of small glass ampule containing a clear, colorless solution of 70% isopropanol and 2% chlorhexidine gluconate and an orange tinted foam pledget inside an applicator. When the ampoule is broken, the solution flows through the pledget and becomes orange in color. This MSDS discusses the hazards of the Chlorhexidine luconate/Isopropanol solution in the ampoule and the final tinted product.
EMERGENCY OVERVIEW
WARNING!
Flammable Liquid and Vapor. Causes severe eye irritation. May cause skin irritation. Inhalation of vapors may cause respiratory irritation and central nervous system effects such as headache, dizziness, drowsiness, nausea and unconsciousness. Harmful if swallowed.


On 7-12-2011 at 10:29 am interview with Director of Inpatient Services (DIS) G revealed the hospital does not have a policy & procedure for a patient catching on fire in the Operating Room (OR). DIS G also explained that the Time Out is completed in 3 phases, it is not fully documented in the medical record and not specific for alcohol based skin prep dry time.

On 7-12-2011 at 11:37 AM Registered Nurse (RN) Y was observed in Operating room #5. RN Y was preparing pt. #37's left shoulder area for surgery. ChloraPrep orange tint was used on pt. #37's left shoulder, arm and clavicle area. Surgeon Z, held the left arm up which allowed the ChloraPrep to run down the arm to the arm pit. At 11:43 AM a time out was completed that included staff in the room, pt. allergies, correct surgery. A verbalization of the skin prep being dry was not part of the time out. At 11:46 AM surgeon Z made the first pass with the caughtery tool.

On 7/13/2011 at 8:20 AM review of pt. #1's record showed pt. #1 had right shoulder surgery on 6/6/2011. The anesthesia record dated 6/6/2011 contains a single box that states, Time Out with a hand written check mark in the box. The anesthesia Block sheet dated 6/6/2011 states ChloraPrep was used and also contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 6/6/2011 contains a box labeled Clip Site, the box is blank. Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7/13/2011 at 1:45 PM review of pt. #21's record showed pt. #21 had back surgery on 8/5/2010. The anesthesia record dated 8/5/2010 contains a single box that states, Time Out with no mark in the box. The Operating Room Nursing Notes form dated 8/5/2010 contains a box labeled Clip Site, the box is blank. The Solution section shows alcohol and ChloraPrep was used with a prep time of 2 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7/13/2011 at 2:52 PM review of pt. #22's record showed pt. #22 had left shoulder surgery on 8/23/2010. The anesthesia record dated 8/23/2010 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 8/23/2010 contains a Solution section that shows ChloraPrep was used with a prep time of 5 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7/13/2011 at 3:09 PM review of pt. #23's record showed pt. #23 had right knee surgery on 2/1/2011. The anesthesia record dated 2/1/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 2/1/2011 contains a box labeled Clip Site, the box states, N/A. The Solution section shows ChloraPrep was used with a prep time of 4 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-13-2011 at 3:45 PM a review of pt. #24 ' s medical record revealed pt. #24 had right knee surgery on 7/12/2011. The anesthesia record dated 7/12/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 7/12/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 3 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-13-2011 at 4:05 PM a review of pt. #25 ' s medical record revealed pt. #25 had right hip surgery on 7/12/2011 . The anesthesia record dated 7/12/2011 contains a single box that states, Time Out with a hand written " OK " in the box. The Operating Room Nursing Notes form dated 7/12/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 3 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.


On 7-13-2011 at 4:20 PM a review of pt. #26 ' s medical record revealed pt. #26 had left knee surgery on 7/13/2011 The anesthesia record dated 7/13/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 7/13/2011 contains a Solution section that shows ChloraPrep was used with a prep time of " painted " . The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.


On 7-14-2011 at 8:55 AM a review of pt. #27 ' s medical record revealed pt. #27 had right and left knee surgery on 7/12/2011. The anesthesia record dated 7/12/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 7/12/2011 contains a Solution section that shows ChloraPrep was used with a prep time of " left + right painted x2 " . The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 9:45 AM a review of pt. #28 ' s medical record revealed pt. #28 had lower back surgery on 7/11/2011. The anesthesia record dated 7/11/2011 contains a single box that states, Time Out with a hand written, " OK " in the box. The Operating Room Nursing Notes form dated 7/11/2011 contains a Solution section that shows alcohol and ChloraPrep were used with a prep time of 2 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 10:20 AM a review of pt. #29 ' s medical record revealed pt. #29 had right knee surgery on 7/13/2011. The anesthesia record dated 7/13/2011 contains a single box that states, Time Out with a hand written, " OK " in the box. The Operating Room Nursing Notes form dated 7/13/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 2 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 10:35 AM a review of pt. #30 ' s medical record revealed pt. #30 had left hip surgery on 7/12/2011. The anesthesia record dated 7/12/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 7/12/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 2 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 10:45 AM a review of pt. #31 ' s medical record revealed pt. #31 had right hip surgery on 7/12/2011. The anesthesia record dated 7/12/2011 contains a single box that states, Time Out with a hand written, " OK " in the box. The Operating Room Nursing Notes form dated 7/12/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 3 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.
.

On 7-14-2011 at 10:55 AM a review of pt. #32 ' s medical record revealed pt. #32 had right hip surgery on 7/13/2011. The anesthesia record dated 7/13/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 7/13/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 5 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 11:05 AM a review of pt. #33 ' s medical record revealed pt. #33 had left shoulder surgery on 7/13/2011. The anesthesia record dated 7/13/2011 contains a single box that states, Time Out with a hand written, " OK " in the box. The Operating Room Nursing Notes form dated 7/13/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 2 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.


On 7-14-2011 at 11:15 AM a review of pt. #34 ' s medical record revealed pt. #34 had left knee surgery on 7/12/2011. The anesthesia record dated 7/12/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 7/12/2011 contains a Solution section that shows ChloraPrep was used with a prep time of " painted " . The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 11:20 AM a review of pt. #35 ' s medical record revealed pt. #35 had right knee surgery on 7/12/2011. The anesthesia record dated 7/12/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 7/12/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 3 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 11:05 AM a review of pt. #36 ' s medical record revealed pt. #36 had lower back surgery on 7/11/2011. The anesthesia record dated 7/11/2011 contains a single box that states, Time Out with a hand written, " OK " in the box. The Operating Room Nursing Notes form dated 7/11/2011 contains a Solution section that shows alcohol and ChloraPrep were used with a prep time of 2 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.



The cumulative effect of these systemic problems resulted in the hospital's inability to ensure the safety of surgical patients.




29972


Findings include:

On 7-13-2011 at 9:40 AM a review of pt. #4's medical record revealed pt. #4 had left hip surgery on 7/6/2010. The anesthesia record dated 7/6/2010 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 7/6/2010 contains a Solution section that shows ChloraPrep was used with a prep time of 5 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-13-2011 at 11:20 AM a review of pt. #5's medical record revealed pt. #5 had left hip surgery on 7/23/2010. The anesthesia record dated 7/23/2010 contains a single box that states, Time Out with a time of 12:46 written in. The Operating Room Nursing Notes form dated 7/23/2010 contains a Solution section that shows ChloraPrep was used with a prep time of 5 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-13-2011 at 3:30 PM a review of pt. #6's medical record revealed pt. #6 had right hip surgery on 2/7/2011. The anesthesia record dated 2/7/2011 contains a single box that states, Time Out which is blank. The Operating Room Nursing Notes form dated 2/7/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 2 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-13-2011 at 3:45 PM a review of pt. #7's medical record revealed pt. #7 had left knee surgery on 5/4/2011. The anesthesia record dated 5/4/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 5/4/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 4 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 9:15 AM a review of pt. #8's medical record revealed pt. #8 had right knee surgery on 5/11/2011. The anesthesia record dated 5/11/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 5/11/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 2 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 9:30 AM a review of pt. #9's medical record revealed pt. #9 had left hip surgery on 4/26/2011. The anesthesia record dated 4/26/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 4/26/2011 contains a Solution section that shows ChloraPrep was used with a prep time not documented. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 9:45 AM a review of pt. #10's medical record revealed pt. #10 had right hip surgery on 4/26/2011. The anesthesia record dated 4/26/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 4/26/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 3 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 10:00 AM a review of pt. #11's medical record revealed pt. #11 had laminectomy fusion surgery on 5/23/2011. The anesthesia record dated 5/23/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 5/23/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 2 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 10:15 AM a review of pt. #12's medical record revealed pt. #12 had left knee surgery on 5/24/2011. The anesthesia record dated 5/24/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 5/24/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 2 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 10:20 AM a review of pt. #13's medical record revealed pt. #13 had left hip surgery on 5/31/2011. The anesthesia record dated 5/31/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 5/31/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 2 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 10:30 AM a review of pt. #14's medical record revealed pt. #14 had left hip surgery on 6/7/2011. The anesthesia record dated 6/7/2011 contains a single box that states, Time Out with a hand written "yes" in the box. The Operating Room Nursing Notes form dated 6/7/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 5 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 10:40 AM a review of pt. #15's medical record revealed pt. #15 had right knee surgery on 6/14/2011. The anesthesia record dated 6/14/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 6/14/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 2 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 10:50 AM a review of pt. #16's medical record revealed pt. #16 had right knee surgery on 6/21/2011. The anesthesia record dated 6/21/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 6/21/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 3 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 11:00 AM a review of pt. #17's medical record revealed pt. #17 had cervical fusion surgery on 6/23/2011. The anesthesia record dated 6/23/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 6/23/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 2 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 11:15 AM a review of pt. #18's medical record revealed pt. #18 had cervical fusion surgery on 6/27/2011. The anesthesia record dated 6/27/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 6/27/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 2 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 11:30 AM a review of pt. #19's medical record revealed pt. #19 had right knee surgery on 7/5/2011. The anesthesia record dated 7/5/2011 contains a single box that states, Time Out with a hand written check mark in the box. The Operating Room Nursing Notes form dated 7/5/2011 contains a Solution section that shows ChloraPrep was used with a prep time of 2 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

On 7-14-2011 at 11:45 AM a review of pt. #20's medical record revealed pt. #20 had left shoulder surgery on 7/26/2010. The anesthesia record dated 7/26/2010 contains a single box that states, Time Out with the time 11:40 written in. The Operating Room Nursing Notes form dated 7/26/2010 contains a Solution section that shows ChloraPrep was used with a prep time of 3 minutes. The Intra-Op Procedure Briefing section states "Surgeon, Anesthesiologist and/or Circulator to Verbalize the following with Entire surgical team prior to incision: Surgical/Procedure Site/ Side Marked, Correct Patient Position, Case Specific Patient Issues/ Equipment Setup & ready, correct implant systems and implants, verify pre-existing implants, verify vertebral level with x-ray, antibiotics, allergies. The list for time out does not contain a check for, skin prep is dry.

Based on record reveiw and interveiw the hospital failed to ensure a complete post-anesthesia evaluation was completed for patients receiving general anesthesia. In 34 of 34 records reviewed the post anesthesia evaluation did not contain the minimum elements of an adequate post anesthesia evaluation.

Findings include:

On 7-13-2011 at 8:20 AM a review of pt. #1 ' s medical record revealed pt. #1 had right shoulder surgery on 6/6/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 6/6/2011 signed by the anesthesiologist that states " + VSS " . The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-13-2011 at 1:45 PM a review of pt. #21 ' s medical record revealed pt. #21 had back surgery on 8/5/2010 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 8/5/2010 signed by the anesthesiologist that states " NIAL ' S " . The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-13-2011 at 2:52 PM a review of pt. #22 ' s medical record revealed pt. #22 had left shoulder surgery on 8/23/2010 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 8/23/2010 signed by the anesthesiologist that states " Pt tolerated procedure well, no apparent anesthetic comps " . The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-13-2011 at 3:09 PM a review of pt. #23 ' s medical record revealed pt. #23 had right hip surgery on 2/1/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 2/1/2011 signed by the anesthesiologist that states " No intraop anesth probs " . The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-13-2011 at 3:45 PM a review of pt. #24 ' s medical record revealed pt. #24 had right knee surgery on 7/12/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 7/12/2011 signed by the anesthesiologist that states " MAAC heart --, VSS, Dilaudid 1.5 mg given to PACU " . The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-13-2011 at 4:05 PM a review of pt. #25 ' s medical record revealed pt. #25 had right hip surgery on 7/12/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 7/12/2011 signed by the anesthesiologist that states " no AC, VSS, Aor3, pt tolerated procedure well-may be discharged to inpt " . The evaluation does not contain a review of respiratory function, cardiovascular function, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-13-2011 at 4:20 PM a review of pt. #26 ' s medical record revealed pt. #26 had left knee surgery on 7/13/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 7/13/2011 signed by the anesthesiologist that states " VSS, awake, spont--- breaths, ao--------, No AC " . The evaluation does not contain a review of cardiovascular function, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 8:55 AM a review of pt. #27 ' s medical record revealed pt. #27 had right and left knee surgery on 7/12/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 7/12/2011 signed by the anesthesiologist that states " pt. stable no comp. d/c ---- meets criteria " . The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 9:45 AM a review of pt. #28 ' s medical record revealed pt. #28 had lower back surgery on 7/11/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 7/11/2011 signed by the anesthesiologist that states " PACV BP ' s 120 to 200 mm Hg, pt c/o pain, decrease BP with IV analgesics, no AC, VSS, A or 3, pt. tolerated procedure well; may be discharged to in pt " . The evaluation does not contain a review of respiratory function, cardiovascular function, temperature, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 10:20 AM a review of pt. #29 ' s medical record revealed pt. #29 had right knee surgery on 7/13/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 7/13/2011 signed by the anesthesiologist that states " no AC, VSS, A or 3, pt tolerated procedure well, may be discharged to in pt " . The evaluation does not contain a review of respiratory function, cardiovascular function, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 10:35 AM a review of pt. #30 ' s medical record revealed pt. #30 had left hip surgery on 7/12/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 7/12/2011 signed by the anesthesiologist that states " + VSS, awake, comfortable no ceta -- " . The evaluation does not contain a review of respiratory function, cardiovascular function, temperature, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 10:45 AM a review of pt. #31 ' s medical record revealed pt. #31 had right hip surgery on 7/12/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 7/12/2011 signed by the anesthesiologist that states " no AC, VSS, A or 3, pt. tolerated procedure well, may be discharged to in pt " . The evaluation does not contain a review of respiratory function, cardiovascular function, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 10:55 AM a review of pt. #32 ' s medical record revealed pt. #32 had right hip surgery on 7/13/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 7/13/2011 signed by the anesthesiologist that states " pt. stable no comp. dia ---- meets criteria " . The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 11:05 AM a review of pt. #33 ' s medical record revealed pt. #33 had left shoulder surgery on 7/13/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 7/13/2011 signed by the anesthesiologist that states " no AC, VSS, A or 3, pt. tolerated procedure well, may be discharged to in pt " . The evaluation does not contain a review of respiratory function, cardiovascular function, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 11:15 AM a review of pt. #34 ' s medical record revealed pt. #34 had left knee surgery on 7/12/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 7/12/2011 signed by the anesthesiologist that states " pt. stable no comp. d/c when meets criteria " . The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 11:20 AM a review of pt. #35 ' s medical record revealed pt. #35 had right knee surgery on 7/12/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 7/12/2011 signed by the anesthesiologist that states " VSS. Awake, spont-breath, adeq---. No AC " . The evaluation does not contain a review of respiratory function, cardiovascular function, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 11:05 AM a review of pt. #36 ' s medical record revealed pt. #36 had lower back surgery on 7/11/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 7/11/2011 signed by the anesthesiologist that states " no AC, VSS, A or 3, pt. tolerated procedure well, may be discharged to in pt " . The evaluation does not contain a review of respiratory function, cardiovascular function, temperature, pain, nausea/vomiting, and postoperative hydration.

At 1:40 PM on 7-13-2011a interview and review of findings with Director of Inpatient Services (DIS) G, was completed. DIS G explained the post anesthesia evaluations do not include the full review. DIS G agreed that all post anesthesia evaluations will not meet the requirement.



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Findings include:

On 7-13-2011 at 9:40 AM a review of pt. #4's medical record revealed pt. #4 had left hip surgery on 7/6/2010 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 7/6/2010 signed by the anesthesiologist that states "A&Ox3 comfortable, vital signs stable, d/c when meets criteria " . The evaluation does not contain a review of respiratory function, cardiovascular function, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-13-2011 at 11:20 AM a review of pt. #5's medical record revealed pt. #5 had left hip surgery on 7/23/2010 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 7/23/2010 signed by the anesthesiologist that states "VSS+ " . The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-13-2011 at3:30 PM a review of pt. #6's medical record revealed pt. #6 had right hip surgery on 2/7/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 2/7/2011 signed by the anesthesiologist that states "NAAC, heart normal, vss, awake". The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 5-4-2011 at 3:40 PM a review of pt. #7's medical record revealed pt.#7 had left knee surgery on 5/4/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 5/4/2011 signed by the anesthesiologist that states, "no intraoperative probems". The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 9:15 AM a review of pt. #8's medical record revealed pt. #8 had right knee surgery on 5/11/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 5/11/2011 signed by the anesthesiologist that states, "no anesthesia complications". The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 9:30 AM a review of pt. #9's medical record revealed pt. #9 had left hip surgery on 4/26/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 4/26/2011 signed by the anesthesiologist that states, "no intraoperative problems". The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 9:45 AM a review of pt. #10's medical record revealed pt. #10 had right hip surgery on 4/26/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 4/26/2011 signed by the anesthesiologist that states "no anesthesia problems" . The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 10:00 AM a review of pt. #11's medical record revealed pt. #11 back surgery on 5/23/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 5/23/2011 signed by the anesthesiologist that states, "No anesthesia complications". The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 10:15 AM a review of pt. #12's medical record revealed pt. #12 had left knee surgery on 5/24/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 5/24/2011 signed by the anesthesiologist that states "vss" . The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 10:20 AM a review of pt. #13's medical record revealed pt. #13 had left knee surgery on 5/31/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 5/31/2011 signed by the anesthesiologist that states "pt stable, no complications, discharge when meets criteria" . The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 10:30 AM a review of pt. #14's medical record revealed pt. #14 had left hip surgery on 6/7/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 6/7/2011 signed by the anesthesiologist that states, "alert and oriented, vss, no apparent anesthetic cx". The evaluation does not contain a review of respiratory function, cardiovascular function, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 10:40 AM a review of pt. #15's medical record revealed pt. #15 had right knee surgery on 6/14/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 6/14/2011 signed by the anesthesiologist that states, "no anesthesia complications". The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 10:50 AM a review of pt. #16's medical record revealed pt. #16 had right knee surgery on 6/21/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 6/21/2011 signed by the anesthesiologist that states, "vss". The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 11:00 AM a review of pt. #17's medical record revealed pt. #17 had cervical fusion surgery on 6/23/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 6/23/2011 signed by the anesthesiologist that states, "A+Ox3, comfortable, vital signs stable, discharge when meets criteria". The evaluation does not contain a review of respiratory function, cardiovascular function, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 11:15 AM a review of pt. #18's medical record revealed pt. #18 cervical fusion surgery on 6/27/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 6/27/2011 signed by the anesthesiologist that states, " pt. stable with no complications, dischage when meets criteria". The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 11:25 AM a review of pt. #19's medical record revealed pt. #19 had right knee surgery on 7/5/2011 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 7/5/2011 signed by the anesthesiologist that states, "NAAC, vss, heart normal". The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.

On 7-14-2011 at 11:35 AM a review of pt. #20's medical record revealed pt. #20 had left shoulder surgery on 7/26/2010 with general anesthesia. The anesthesia record shows a post anesthesia evaluation dated 7/26/2010 signed by the anesthesiologist that states "vss" . The evaluation does not contain a review of respiratory function, cardiovascular function, mental status, temperature, pain, nausea/vomiting, and postoperative hydration.