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Based on record review and interview, the facility failed to ensure that consent for treatment signatures were obtained on all Emergency Department patients or their representatives in 4 patients admitted through the emergency department (Patient #4, #5, #6, and #10) in a total of 15 Emergency Department medical records reviewed.

Findings include:

The facility policy titled "Consent for Treatment & Financial Agreement" #7590388, last revision date 2/03/2020 revealed "The Consent for Treatment... is obtained by registration staff and/or staff of departments where patients present for services... With each episode of care for all services including, emergency room, inpatient." Under Procedure Consent Form revealed "The patient must be provided a copy of the document to review the content prior to signing." Under Signature revealed "The patient's signature is always obtained when the patient is of legal age (18 years old)."

Patient #4's medical record was reviewed and revealed Patient #4 was a 58-year-old seen in the emergency department on 8/02/2021 at 4:19 PM for chest pain and was discharged home 8/03/2021. There was no documented "Consent for Treatment" in Patient #4's medical record for this visit.

Patient #5's medical record was reviewed and revealed Patient #5 was a 65-year-old seen in the emergency department on 8/02/2021 at 6:46 PM for chest pain and admitted to the hospital at 9:20 PM. There was no documented "Consent for Treatment" in Patient #5's medical record for this visit.

Patient #6's medical record was reviewed and revealed Patient #6 was a 37-year-old seen in the emergency department on 7/05/2021 at 6:47 PM for chest pain and eloped at 7:50 PM. There was no documented "Consent for Treatment" in Patient #6's medical record for this visit.

Patient #10's medical record was reviewed and revealed Patient #10 was a 61-year-old seen in the Emergency Department on 8/07/2021 at 9:41 AM for shortness of breath and history of schizophrenia and admitted to the hospital. There was no documented "Consent for Treatment" in Patient 10's medical record on 8/10/2021 at 11:50 AM during review of Patient #10's inpatient medical record.

On 8/09/2021 at 12:45 PM during interview with Patient Access Representative Q, Q stated "no" we don't offer consent for treatment or "give patient rights in writing."

On 8/11/2021 at 8:53 AM during interview with Registration Lead L, when asked if consent for treatment was present in the electronic medical records of Patient #4, #5, #6 or #10, Lead L stated "No. I don't see them."

Based on interview, observation, and record review, the facility failed to provide a safe setting by failing to identify, report, and communicate equipment and department safety risks to enable nursing staff to provide care to their patients in an effective and efficient manner as observed during care of 1 of 18 patients receiving care in the Emergency Department on 8/09/2021 (Patient #16) in a total of 1 of 2 departments observed (Emergency Department).

Findings include:

On 8/09/2021 at 1:32 PM, during ED tour with Emergency Department Manager C, an attempt to close the glass sliding door to Room #18 was unsuccessful. A cable wrapped with a rubber band with no note was sitting on the table outside of the ED nursing station.

On 8/09/2021 at 1:32 PM during interview with ED Manager C, when ED Manager C was questioned how long the door to room #18 has not been working, ED Manager C stated that's the "first I knew about" it. When questioned what happens with equipment that does not work, ED Manager C stated equipment is marked, "out of order" and placed on the table outside of the ED nursing station, and written on the communication clipboard noting that a work order has been placed. If something needs to be fixed in the department, a work order to maintenance is placed, and also documented on the communication clipboard. When questioned why the cable was on the table, ED Manager D looked at the clipboard and stated it has a short, a work order has been placed, and stated "I will need to check" on the status.

Record review of Standard Operating Procedure policy "Equipment Repairs" # TMX-SOP-0087 dated 4/20/2018 under Purpose-Scope revealed "be completed... to ensure... serviced equipment will meet performance specifications upon clinical use." Under In House Repair 6.6.3 revealed "For component / part level type of problem, the technician will determine whether parts need to be ordered and order those either from manufacturer or source the parts from an approved supplier... After all repairs, the technician must conduct a full performance, safety inspection and even re-calibration where needed."

Record review of Emergency Department's communication clip board for broken equipment, paper titled "Broken Equipment Log" under column titled Type of Equipment that is broken, with "Pulse ox [oximeter] Cord has a short CE (low risk medical device) 30202326." Under column titled Date Called in for Repair Maintenance: "7/30/2021 C03821382" was hand-written in. There were no comments or a part number indicating a part needed to be ordered or that the repair had been completed. There was no documentation of Room 18 door being off the track.

Record review of Service History Report of CEID# 30202326 for pulse oximeter cords created 07/30/2021 at 12:31 PM Completed 7/30/2021 at 1:38 PM under What actions were taken to ensure the device was ready for patient, note dated 7/30/2021 at 1:48 PM revealed "Provided the nursing staff with a part number. Part Number: LNC-10."

On 8/10/2021 at 9:10 AM interview with ED Manager C and Clinical Engineering Manager N, Manager N stated nursing staff was given the part number for the cord repair and stated "we don't order that." ED Manager C stated "I wasn't notified."

On 8/11/2021 at 9:25 AM during interview with Plant Operation Manager O, Manager O stated there was not a work order placed for the Emergency Department's sliding door for Room #18 prior to 8/10/2021 and stated "it was fixed yesterday."

On 8/11/2021 at 9:23 AM during interview with Quality Coordinator J, Coordinator J confirmed there was no written hospital policy or process for reporting broken equipment or other departmental needs that need repairs.