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Based on the review of medical records (MR), facility documentation and interview with facility staff (EMP) it was determined that Tyrone Health Regional Health Network failed to provide medical supervision to the Certified Registered Nurse Anesthetist (CRNA) relating to the requirement of medication and treatment orders being signed by a practitioner in five of five medical records (MR8, MR9, MR10, MR11 and MR12).

Findings Include:

Review of "Tyrone Health Regional Health Network Tyrone Hospital, Medical Staff Bylaws" dated April 2018, revealed, "... Article VI Allied Health Professionals 1. Definition: 1-1. For the purpose of these Bylaws, Allied Health professionals (AHP's) are individuals, other than the Medical Staff members, who are duly qualified by training, experience or certification and/or licensure to provide specific patient care services in collaboration with and under the direct supervision of an active or associate member so [sic] the Medical Staff. ... ."

1. Review of facility documentation entitled, "Tyrone Hospital Nurse Anesthetist - Core Privileges revealed, "... Procedures: ... Prescribe perioperative medications approved by the Medical Staff. ... ."

2. MR8 documentation entitled, The Tyrone Hospital-Physician's Order Sheet ... PACU Anesthesia Orders ... noted a designated space for Physician's Signature which revealed only the signature of the Certified Registered Nurse Anesthetist (CRNA).

3. MR9 documentation entitled, The Tyrone Hospital-Physician's Order Sheet ... PACU Anesthesia Orders ... noted a designated space for Physician's Signature which revealed only the signature of the Certified Registered Nurse Anesthetist (CRNA).


4. MR10 documentation entitled, The Tyrone Hospital-Physician's Order Sheet ... PACU Anesthesia Orders ... noted a designated space for Physician's Signature which revealed only the signature of the Certified Registered Nurse Anesthetist (CRNA).


5. MR11 documentation entitled, The Tyrone Hospital-Physician's Order Sheet ... PACU Anesthesia Orders ... noted a designated space for Physician's Signature which revealed only the signature of the Certified Registered Nurse Anesthetist (CRNA).


6. MR12 documentation entitled, The Tyrone Hospital-Physician's Order Sheet ... PACU Anesthesia Orders ... noted a designated space for Physician's Signature which revealed only the signature of the Certified Registered Nurse Anesthetist (CRNA).


EMP7 confirmed the above findings that the signatures were EMP7's only and none of the Physician Orders were cosigned by a practitioner.

Based on a review of medical records (MR) and facility documents, and interview with facility staff (EMP) it was determined that Tyrone Regional Health Network failed to follow their adopted policies by failing to identify the type of anesthesia on the anesthesia consent prior to patient's surgical procedure in five of five medical records (MR8, MR9, MR10, MR11 and MR12), and by failing to obtain a complete physican order for restraints prior to applying physical restraints, and by failing to include restraints in the patient's care plan in three of three medical records (MR5, MR6 and MR7).

Findings Include:

Review of Tyrone Regional Health Network ... Tyrone Hospital ... PolicyStat ID: 4117581 ... Patients Rights & Responsibilities policy dated October 2017. "Rights: ... The patient has the right to expect good management techniques to be implemented within the hospital considering effective use of your time and to avoid your personal discomfort. ... Except for emergencies, the physician must obtain the necessary informed consent prior to the start of any procedure or treatment, or both. ... ."

Review of Tyrone Regional Health Network ... Tyrone Hospital ... PolicyStat ID: 4118067 ... Acceptance of Patients for Anesthesia Services ... policy dated April 2018. "... Policy: ... 2. A consent form for the proposed procedure and anesthesia is completed and recorded in the patient's medical record, ... ."

Review of Review of Tyrone Regional Health Network ... Tyrone Hospital ... PolicyStat ID: 4117869 ... Consents ... policy dated October 2017. "A written consent is required for all routine diagnostic tests and treatments of all in-patients and out-patients. ... It is the responsibility of the physician to obtained informed consent. Consent forms are not valid if signed after anesthesia or sedation. ... All consents are placed in the medical record. ... ."

Review of Review of Tyrone Regional Health Network ... Tyrone Hospital ... PolicyStat ID: 4118179 ... Restraints/Safety Devices ... policy dated October 2017. "... Procedure: I. General Information A. Patient Rights: 1. Tyrone Hospital recognizes that all patients have the right to considerate, respectful care at all times, with recognition of their personal safety, dignity and well-being. ... 3. Include restraints on POC. C. Physcian Order-No prn orders permitted. ... A physician order must be obtained as soon as possible for all patients in which restraints are deemed necessary. The order shall include: 1. Time limited-indicates how long may use, not to exceed 24 hours. 2. Reassessed by physician to determine a continuing need for restraint at least once each calendar day. 3. Reason for restraint. 4. Type of restraint ... ."

1. Review of MR8-MR12 Consent for Anesthesia failed to reveal the type of anesthesia that was to be administered prior to the procedure.
MR8-MR12 inclusively revealed, "Tyrone Hospital Your Health Our Care Anesthesia Consent ... ALL Types of anesthesia involve SOME RISK. ... The type of anesthesia services that you receive is determined by factors including your physical condition, the nature of the procedure, the preference of your physician and YOUR preference. A type has been recommended for you and sometimes an anesthetic technique may not succeed completely and therefore another technique from the following may have to be used. Check or Circle What Is Appropriate ... General Anesthesia ... Spinal or Epidural Anesthesia ... Nerve Block ... Intravenous Regional ... Monitored Anesthesia Care With or Without Sedation ... Pain Management Block ... ."

Interview with EMP5 confirmed that MR8, MR9, MR10, MR11 and MR12 failed to reveal any "circle" or "check" to indicate the anesthesia selection.

2. Review of MR5 revealed an incomplete electronic restraint order dated January 18, 2018, at 11:01 PM. There was no documentation entered under the sections entitled, "Episode Description," "Clinical Justification," "Less Restrictive Alternatives," or "Type of Restraint Ordered."

3. Review of MR6 revealed an incomplete electronic restraint order dated November 28 2017, 8:02 AM. There was no documentation entered under the sections entitled, "Episode Description," "Less Restrictive Alternatives," or "Type of Restraint Ordered."

4. Review of MR7 revealed an incomplete electronic restraint order dated October 27, 2017. There was no documentation entered under the sections entitled, "Less Restrictive Alternatives."

Interview with EMP3 confirmed that MR5-MR7 revealed incomplete physician orders for restraints and confirmed there was no documented evidence of restraints on the nursing care plan.