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REGIONS HOSPITAL
STAFFING AND DELIVERY OF CARE
Tag No.: A0392
Based on interview and document review, the hospital failed to ensure emergency department (ED) policies and guidance were followed as directed for 1 of 10 patients (P1) whose medical records were reviewed.
Findings include:
P1's medical record indicated P1 was admitted 2/26/23. P1's diagnoses included sickle cell crisis, pain, tachycardia, anemia, and 16 weeks gestation of pregnancy. P1's medical record indicated P1's medical providers and nursing staff did not obtain any fetal heart tone (FHT) monitoring nor had a obstetric consult been ordered for P1. On 2/28/23, P1 developed abdominal pain and bleeding, and was found to have had a miscarriage at 16-18 weeks gestation.
On 3/22/23, at 9:40 a.m. during an interview with the Department Chair of Emergency Medicine medical doctor (MD)-A stated he would have expected all emergency department policies and procedures to be followed. MD-A stated the guidance set forth was for pregnant patients to have FHT monitoring as part of vital signs, and this did not occur.
On 3/22/23, at 11:30 a.m. during an interview with obstetric physician (OB)-A, she stated she would have expected there to have been an OB consult requested in the emergency department (ED) and FHT taken upon admission to the ED. OB-A stated this would not have changed the outcome in this situation. OB-A stated a fetus at 16-18 weeks is not considered to be a viable fetus; however, she would still have wanted to have obtained the FHT or an ultrasound when the mom presented with medical conditions.
The facility policy Gyn, Obstetrics and Breast Guidelines dated January 2023, Medical Complaint Not Related to Pregnancy directed less than 20.0 weeks gestation are to be evaluated in ED; consult OB/GYN as appropriate. Pregnant patients greater that 12 weeks need fetal heart tones: if an ED patient is pregnant, the expectation is that nursing will check and document fetal heart tones (FHT) if >12 weeks gestation regardless of the complaint. This is considered a vital sign in this patient population.