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Based on observation and staff interview the facility failed to ensure surface areas were intact on cupboard surfaces in the post operative recovery area and in the clean work instrument work area. This had the ability to affect all surgical patients. The facility had 324 surgical patients in the past 6 months.

Findings are:

A. Observations conducted during the surgical tour on 8/29/18 at 2:30 PM revealed:
-There were two missing areas, approximately 2 inches long, on the front surface of the countertops in one area of the post operative recovery room. There was other missing counter top areas over by the sink. These areas were marked by white adhesive tape.
-The clean instrument room had large missing front areas of counter top missing approximately 3 feet in length.

B. Interview with RN (Registered Nurse) A on 8/29/18 at 2:30 AM revealed the white tape marked that indicated for maintenance the area to be fixed. RN A stated that a maintenance requisitions had been submitted for both the post operative recovery room and clean instrument room.

Based on medical record review and staff interview, the CAH (Critical Access Hospital) failed to ensure the physician examined the patient immediately before surgery for 4 of 4 outpatient surgical patients (Patients 17, 18, 19, and 20) reviewed. This failed practice had the potential to affect all surgical patients of the CAH. Total procedure/ surgeries in the past 6 months was 324.

Findings are:

A. Review of Patient 17's medical record revealed the patient had a endoscopic carpal tunnel release (a scope is used to surgically release the median nerve to release the pain, numbness in the hand ). The patient signed the surgical permit at 7:50 AM. Anesthesia signed that the patient's condition and information reviewed and patient cleared for surgery at 6 AM, before the patient was admitted. The physician signed that the procedure was reviewed, risked, benefits and possible consequences of the procedure with the patient. The physician had reviewed the history and physical and the patient was cleared for surgery. The physician signed this statement at 9:45 AM. The patient's Anesthesia Record stated that the patient was under anesthesia at 9:20 AM.

Review of Patient 18's medical record revealed the patient had a colonoscopy (a flexible tube is inserted through the anus into the colon to view the lining of the colon). The patient signed the surgical permit at 12:05 PM. Anesthesia signed that the patient's condition and information reviewed and patient cleared for surgery at 10:55 AM, before the patient was admitted. The physician signed that the procedure was reviewed, risked, benefits and possible consequences of the procedure with the patient. The physician had reviewed the history and physical and the patient was cleared for surgery. The physician signed this statement at 1335 (1:35 PM). The patient's Anesthesia Record stated that the patient was under anesthesia at 1330 (1:30 PM).

-Review of Patient 19's medical record revealed the patient had an EGD (esophagogastroduodenoscopy: a tube inserted through the mouth to examine the lining of the esophagus, stomach, and first part of the small intestine. The patient signed the surgical permit at 7:20 AM. Anesthesia signed that the patient's condition and information reviewed and patient cleared for surgery at 8:15 AM. The physician signed that the procedure was reviewed, risked, benefits and possible consequences of the procedure with the patient. The physician had reviewed the history and physical and the patient was cleared for surgery. The physician signed this statement at 8:20 AM. The patient's Anesthesia Record stated that the patient was under anesthesia at 8:17 AM.

-Review of Patient 20's medical record revealed the patient had a bilateral myringotomy and tube (treatment for middle ear infections tubes are placed in the eardrums for air and drainage to get out). The patient's family signed the surgical permit at 8:35 AM. Anesthesia signed that the patient's condition and information reviewed and patient cleared for surgery at 8 AM, before the patient was admitted to the hospital.

B. Interview with the Surgical Services Director (8/29/18 at 2:30 PM) confirmed the surgeons see the patients in the pre-operative area.

C. Review of the facility OPERATING ROOM POLICIES-SPECIFIC CONSENT FOR SURGERY dated 1/99, states "The surgeon will note that he has reviewed procedure, risks, benefits and possible consequences of procedure with patient. Anesthesia shall document that the anesthesia to be provided and the risks, benefits and possible consequences has been reviewed with the patient.