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Based on observation, interview, and review of the admission packet, the provider failed to inform patients a physician was not on-site 24 hours per day/seven days a week. Findings include:

1. Observation on 8/2/22 at 3:30 p.m. of the emergency department (ED) revealed there were no signs at the entrance or in the emergency rooms to inform patients a physician was not on-site 24 hours per day/seven days a week.

2. Review of the provider's Admission Packet revealed the following information:
*Patient rights.
*Advanced directive and living will for healthcare.
*Consent for treatment and release of information to insurance.
*The emergency room signature sheet listed:-A consent for treatment.
-Release of information.
-Privacy practices.
*There was no information regarding the provider's coverage 24 hours per day/seven days a week for a patient signature or acknowledgement.

3. Interview on 8/3/22 at 5:00 p.m. director of nursing B and health information manager D about physician availability and patient notification revealed:*They were not aware that information was to have been available for patients.
*The physician availability statement was not present on inpatient admission documentation.
*They agreed there was no statement on the admission information sheet stating a physician was not on-site 24 hours per day/seven days a week. This was prior to 8/1/22 when an updated electronic medical record had started.
*There was no policy for it to have been included in the patient information.
*They agreed there was not a physician available in the building 24 hours per day/seven days a week.

Based on interview, record review, and policy review, the provider failed to ensure staff followed blood administration procedures which included:
*Two of two sampled patients (2 and 3) had double verification signatures by nurses prior to a blood administration, to ensure accurate blood products for patients.
*Three of three sampled patients (1, 2, 3) had a signed consent prior to the blood transfusion.
Findings include:

1. Record review of the 12/10/20 blood administration record for patient 3 revealed:
*He had received one unit of blood.
*The unit of blood had been signed out of the laboratory by an unidentified lab staff but had not been signed out by a nurse prior to the administration to the patient.
*He had not signed a consent for a blood transfusion prior to administration of blood products.

2. Record review of the 3/25/22 blood administration record for patient 2 revealed:
*He had received one unit of blood.
*The unit of blood had been signed out of the laboratory by unidentified lab staff and one nurse.
-It had not been verified by another person at the patient's bedside prior to administration.
*He had not signed a consent for a blood transfusion prior to the administration of blood products.

3. Record review of the 6/19/22 blood administration record for patient 1 revealed:
*She had received two units of blood.
*She had not signed a consent for a blood transfusion prior to the administration of blood products.

Interview and record review on 8/3/22 at 3:35 p.m. with infection control coordinator C regarding missing signatures and consents revealed:
*She had been unable to locate the blood transfusion consents for patients 1, 2, and 3 in their medical records.
*Upon review of the blood administration record for patients 2 and 3, the signatures had been missing for the double verification of the blood products prior to the administration.
*She had been unsure why the double signatures and consents had not been obtained prior to the administration of blood products.

Interview on 8/3/22 at 4:45 p.m. with chief executive officer A regarding the missing documentation revealed:
*The consent for blood transfusions needed to be obtained prior to administration of blood products.
*Agreed policies and procedures should have been followed for verification of blood products prior to transfusion.

Review of the provider's January 2022 Blood Administration Policy revealed:
*Obtained consent for transfusion of blood and blood products.
*The registered nurse should have verified the correct unit of blood by checking for the correct name and date of birth on the unit.
*The registered nurse and another staff person should have verified the patient's name, patient identification and product type on the following forms to ensure the correct patient and correct type for the patient.