HospitalInspections.org

Based on interviews and document review, the hospital failed to delineate privileges to surgical first assistants who performed endoscopic saphenous vein harvesting and other advanced surgical tasks during surgery. This had the potential to affect all patients who had surgery at the hospital.
Findings:
On 01/15/2016, the Chief Operating Officer/Chief Nursing Officer (COO/CNO) and the Director of Surgery were asked if the surgery department maintained a privileges roster for the tasks certified surgical technologist first assistants (CSTFA) and registered nurse first assistants (RNFA) could perform. They stated there was no documentation of this in the department.

Hospital surgical staff job descriptions documented RNFA and CSTFA could perform saphenous vein harvesting and other advanced surgical tasks at the hospital. One of three first assistant employment files reviewed had no documentation competency had been evaluated for first assistant tasks assigned during surgery.

The COO/CNO and the Director of Surgery confirmed the CSTFA and the RNFA staff performed endoscopic saphenous vein harvesting and other advanced surgical tasks during cardiovascular surgeries. They stated some of these tasks were performed at times without the direct supervision of the attending surgeon.

Twenty of twenty patient surgery records reviewed had documentation CSTFA and RNFA staff performed vein harvesting as a part of the cardiovascular surgical procedure.

Review of the current medical staff bylaws, rules and regulations provided by the hospital indicated the medical staff and the governing body had not required formal delineation of the surgical privileges and had not determined what level of supervision would be required for the surgical tasks the CSTFA and the RNFA staff could perform.

Based on surgical staff interviews and hospital documentation, the hospital failed to properly execute an informed consent for ten (#5, 6, 7, 8, 10, 11, 12, 13, 14 and #15) of twenty patients who underwent coronary artery bypass graft (CABG) surgery with saphenous vein harvesting.
Findings:
On the afternoon of 01/15/2016, the surveyors reviewed a hospital document titled, "Oklahoma Heart Hospital Medical Staff Rules and Regulations" approved on 05/04/15. It documented, "... The informed consent form shall include: ...the name of the practitioner(s) performing the procedure(s) or important aspects of the procedures, as well as the name(s) and specific significant surgical tasks that will be conducted by practitioners other than the primary surgeon/practitioner (significant tasks include: harvesting grafts, dissecting tissue, removing tissue, implanting devices, altering tissues..."
Twenty patient records were reviewed for documentation of informed consent for surgical procedures. Ten of the twenty surgical consent forms failed to document a surgical first assistant would perform saphenous vein harvesting. Staff F confirmed the informed consent forms were missing required information.