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Based on observation, policy review, record review and staff interview, the Critical Access Hospital (CAH) failed to ensure monitoring of the equipment commonly used in life-saving procedures for 1 of 4 defibrillators (Operating Room) observed. Failure to monitor equipment as required limited the CAH's ability to ensure properly functioning equipment for life-saving patient treatment.

Findings include:

Review of the policy titled "Checking the Crash Cart" occurred on 10/16/24. This policy, revised March 2021, stated, ". . . WEEKLY AND AFTER EACH USE: 1. Check the . . . defibrillator for proper battery charge. . . . 2. Do a weekly check of the defibrillator at 30 joules, the pacer and the recorder. . . ."

On 10/15/24 at 11:00 a.m. during observation of operating room (OR), an administrative nurse (#1) stated the OR staff check the defibrillator each procedure day or at least weekly.

Reviewed on 10/15/24, the 2023 and 2024 maintenance records for the OR defibrillator failed to include documentation of at least weekly monitoring.

Based on record review, review of the facility's medical staff rules and 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 Allied Health Professionals (AHP) (nurse practitioners, clinical nurse specialists, certified nurse midwives, or physician assistants) for 2 of 10 closed records (Patient #2 and #20) reviewed who were admitted and cared for by a nurse practitioner or physician assistant. Failure to ensure a physician periodically reviewed and signed records of inpatients cared for by the AHP limited the CAH's ability to ensure the quality and appropriateness of patient care provided.

Findings include:

Review of the CAH's current "Medical Staff Rules and Regulations" occurred on 10/16/24. The regulations, dated August 2024, stated, ". . . A physician must review and sign all inpatient records developed by Allied Health Professionals for patients seen by such Allied Health Professionals. . . ."

On the afternoon of 10/14/24, the CAH provided a list of inpatient admissions from April 1 - October 14, 2024. Review of the medical records occurred on all days of survey. The records identified a nurse practitioner or physician assistant admitted the following patients to the CAH, but lacked evidence a physician reviewed and signed the records:
* Patient #2 admitted on 09/08/24.
* Patient #20 admitted on 06/29/24.

During an interview on 10/16/24 at 12:15 p.m., an administrative staff member (#2) confirmed she was unable to locate evidence a physician reviewed and signed Patient #2 and #20's inpatient records.

Based on record review, policy review, and staff interview, the Critical Access Hospital (CAH) failed to ensure staff notified a medical doctor (MD) or doctor of osteopathy (DO) of a patient's admission to the CAH by a nurse practitioner (NP) or physician assistant (PA) for 3 of 20 records (Patient #2, #3 and #20) reviewed who were admitted by an NP or PA. Failure of staff to notify the MD/DO of patients admitted by an NP or PA limited the MD/DO's ability to ensure the appropriateness of the admission and to monitor the care provided to the patients by the NP or PA.

Findings include:

Review of the policy titled "Physician Review of Allied Health Care Professional Patient Records and Allied Health Care Professional Physician Notification of Admission" occurred on 10/16/24. This policy, dated May 2018, stated, ". . . The Allied Health Professional . . . will notify an on-staff physician of a patient's admission to Acute Care/Inpatient . . . and provide documentation in the patient's record of the notification. . . . "

Review of patient medical records occurred on all days of survey. The following records of patients admitted by an NP or PA lacked evidence the CAH staff notified an MD of the admissions:
* Patient #2 admitted on 09/08/24.
* Patient #3 admitted on 10/14/24.
* Patient #20 admitted on 06/29/24.

During interview on 10/16/24 at 12:15 p.m., an administrative staff member (#2) confirmed mid-level practitioners (nurse practitioners and physician's assistants) are required to notify the MD/DO of a patient's admission.