HospitalInspections.org

Based on review of medical records, staff interview, and review of facility documents, it was determined that the facility failed to ensure that the governing body implements physician on-call requirements in accordance with the physician's contracts.

Findings include:

The facility failed to ensure that the on-call Obstetrician/Gynecologist (OB/GYN) is available and present to assure safe patient care and delivery for all obstetrics patients. (Cross reference to Tag 0067)

C#NJ00167658

Based on medical record review, staff interview, and review of facility documents, it was determined that the facility failed to ensure that the on-call Obstetrician/Gynecologist (OB/GYN) is available and present to assure safe patient care and delivery for all obstetrics patients.

Findings include:

A review of the facility document titled, "On-Call OB/GYN Services Agreement" states, "1. Duties. ...Physician is required to be physically present at the hospital to provide services. Pursuant to the on-call requirements for physician's specialty ... Physician shall also be available to advice, consult, and/or perform medical services in order to ensure continuity of care. ... A. Schedule Physician shall provide Services in accordance with the monthly schedule developed by the Chief of OB/GYN department. Physician hereby agrees to adhere to such on-call schedule and to abide by Hospital's reasonable policies with respect to such on-call schedule. In the event a physician is not available to provide coverage, it is Physician's sole responsibility to arrange alternate coverage by a physician who satisfies the requirements set forth in Section 3 of this Agreement and who is subject to approval by Hospital. Where Physician obtains alternate coverage, Physician shall provide Hospital with an updated call coverage schedule and contact phone number. ..."

On 10/5/23 at 10:59 AM, during medical record review with S7 (Registered Nurse), the following was revealed:

On 9/19/23 at 5:29 AM, Patient#6 (P6), a 27-week-pregnant patient, arrived through the ED (Emergency Department) with abdominal pain and was admitted directly to the Labor and Delivery (L&D) unit. S37 (Registered Nurse) documented the following nursing note, "0600 [6:00 AM]- Dr. [S34] [patient's private care OB/GYN] notified of patient contractions & urine results. LR (lactated ringers - intravenous fluid) bolus started. 0630 [6:30 AM]- Notified Dr. [S34] of SROM [spontaneous rupture of membranes]. 0635 [6:35 AM] - Called on-call OB [S21]. 06:40 [6:40 AM]- Pt. [patient] felt something between her legs, nurse checks, prolapsed cord present. Pt felt the urge to push. No doctor present in room. Level 2 nursery called to room. 0645 [6:45 PM] - Viable baby boy born. Resuscitation measures performed by nursery nurse."

At 2:06 PM, a review of the OB/GYN physician On-Call schedule, revealed that on 9/18/23 from 7PM - 7AM, S21 was documented as being on call, with S42 as the 2nd on-call physician.

A review of the facility's incident and occurrence report indicated that when P6 began complaining of increasing contraction pain, S21 was called and there was no response, with the call going to voicemail. At 6:30 AM, when the patient's membranes ruptured, S21 was called again, there was no response, and the call went right to voicemail. P6 then presented with a prolapsed cord (the umbilical cord exits the cervical os before the fetal presenting part. compression of the cord results in fetal hypoxia which can lead to death) and there was no doctor in the house. S21 was called again with no response, and the call went to voicemail. The nursery nurse was called to the room, and the baby was born breech (the fetus's buttocks, feet, or both are in place to come out first during birth) without a doctor present.

10/5/23 at 3:06 PM, upon request, S16 provided a copy of the "On-Call OB/GYN Services Agreement" signed by S21 on 7/24/23. Upon interview, S16 stated that "whoever is on-call should be physically here" as indicated in the Services Agreement; and whoever is "2nd call" has to be "a phone call away."

Upon request for any other occurrences involving on-call for the past 6 months, S1 (Director of Quality) provided documentation of an occurrence in the L&D unit. On 9/10/23 at 12:43 PM, P19 gave birth without a provider in the room, and the on-call doctor was not present in the building. A review of the OB/GYN physician On-Call schedule revealed that on 9/10/23 for the 7AM-7PM shift, S22 was the on-call physician.

10/5/23 at 4:46 PM, a telephone interview with S20 (Chair of Obstetrics) in the presence of S1 was conducted. S20 stated that on 9/19/23, when an OB/GYN was called for P6, P21 (On-Call OB/GYN) had switched call with another provider, and there was no communication provided to the facility staff. On 9/10/23, when the OB/GYN was called for P19 and the on-call doctor (S22) was not present at the facility, S20 stated that he/she was aware of what happened and had tried to contact [S22], however he/she hasn't heard back from them [S22].

The above findings resulted in an Immediate Jeopardy on 10/5/23. The Director of Quality and Chief Nursing Officer were informed of the IJ and were provided with the IJ template on 10/5/23 at 6:34 PM. An acceptable removal plan was received on 10/6/23, the last day of survey. The facility mitigated the immediate jeopardy findings by educating the On-Call OB/GYN providers and implementation of an on-call provider sign in sheet. Implementation was verified during staff interviews and review of facility documents; the IJ was removed as of 10/6/23 at 2:01 PM.

C#NJ00167648

Based on the review of eight of eight medical records (#1-4 and #18-21), staff interview, and review of facility documents, it was determined that the facility failed to ensure that nursing shift assessments are completed in accordance with facility policy and procedure.

Findings include:

Review of the facility policy titled, "Patient Assessment/Reassessment Critical Care and Medical Surgical Units" states, " ...IV. Reassessment of Patient's Condition A. Reassessment of the patient's condition is the responsibility of the registered nurse, as well as the interpretation of the assessment. ...C. Reassessment of the patient is done at least the following times: 1. At the start of the shift and during the shift as needed. ..."

On 10/5/23 at 10:38 AM, on the Psychiatric Medical Care Unit (PMCU), during medical record review with S3 (Director) and S8 (Registered Nurse), the following was revealed:

On 9/18/23, during the 7pm-7am shift, there was no documentation of patient reassessments by a registered nurse for eight of eight patients (Patient #1 (P1)-P4 and P18-21).

An interview with S3, on 10/5/2023 at 12:23 PM, revealed the following: On the 7pm-7am shift on 9/18/2023, there were two (2) RNs and (1) LPN scheduled to work. Two (2) of two (2) RNs called out. Due to callouts and inability to find coverage, S45 (RN HUB Supervisor) covered the PMCU from 11pm-7am. During the interview it was stated that S45 lacked the ability to document in the eMR (electronic Medical Record) on the PMCU as access to the eMR for patients admitted to the PMCU is "restricted" to staff directly involved with patient care. S3 confirmed that there was no documented evidence of documentation that a shift assessment/reassessment was performed by the registered nurse on the 7pm-7am shift on 9/18/2023 for the eight patients reviewed.