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Based on record review, review of the facility's "Medical Staff Rules & Regulations," and staff interview, the Critical Access Hospital (CAH) failed to ensure a doctor of medicine or osteopathy periodically reviewed and signed the records of all inpatients cared for by a nurse practitioner (NP), physician's assistant (PA), or clinical nurse specialist for 6 of 20 discharged patients (Patient #13, #14, #16, #17, #18, and #20) reviewed. Failure to periodically review and sign records of inpatients cared for by a NP, PA, or clinical nurse specialist limited the CAH's ability to ensure the quality and appropriateness of the patient care provided.

Findings include:

Review of the CAH's current "Medical Staff Rules & Regulations" occurred on 11/20/24. The rules and regulations stated, ". . . All entries by physician assistants and medical students shall be co-signed by a member of the active Medical Staff. . . ."

On the afternoon of 11/18/24, the CAH provided a list of inpatient admissions from May 21-November 2, 2024. Review of the medical records occurred on all days of survey. The records identified a nurse practitioner or physician's assistant admitted the following patients to the CAH, and failed to show a physician reviewed/signed the records:
* Patient #13 admitted on 08/05/24.
* Patient #14 admitted on 09/17/24.
* Patient #16 admitted on 10/09/24.
* Patient #17 admitted on 10/05/24.
* Patient #18 admitted on 08/21/24.
* Patient #20 admitted on 11/02/24.

During an interview on 11/20/24 at 11:05 a.m., a managerial nurse (#1) confirmed she was unable to locate evidence a physician reviewed and signed Patient #13, #14, #16, #17, #18, and #20's inpatient records.

Based on record review, review of the facility's "Medical Staff Rules & Regulations," and staff interview, the Critical Access Hospital (CAH) failed to ensure staff notified the medical doctor (MD) or doctor of osteopathy (DO) when a nurse practitioner (NP), physician's assistant (PA), or clinical nurse specialist admitted a patient to the CAH for 5 of 20 discharged patients (Patient #7, #13, #17, #18, and #22). Failure of staff to notify the MD/DO of patients admitted by a NP, PA, or clinical nurse specialist limited the physician's ability to ensure the appropriateness of the admission and to monitor the care provided to the patients.

Findings include:

Review of the CAH's current "Medical Staff Rules & Regulations" occurred on 11/20/24. The rules and regulations stated, ". . . All entries by physician assistants . . . shall be co-signed by a member of the active Medical Staff. . . ."

Review of patient medical records occurred on all days of survey. The records identified a NP or PA admitted the following patients to the CAH, and failed to show staff notified a physician of the admissions:
* Patient #7 admitted on 07/20/24.
* Patient #13 admitted on 08/05/24.
* Patient #17 admitted on 10/05/24.
* Patient #18 admitted on 08/21/24.
* Patient #22 admitted on 07/30/24.

During an interview on 11/20/24 at 11:05 a.m., a managerial nurse (#1) confirmed she was unable to locate evidence staff notified the physician when a NP or PA admitted Patient #7, #13, #17, #18, and #22.