HospitalInspections.org

A. Based on Hospital policy, record review and staff interview, it was determined that the Hospital failed to follow its policy requiring anesthesia services to be contacted for all emergent or urgent surgical cases in 1 out 8 surgical cases reviewed (Pt. #1).

Findings include:

1. The surgical policies and procedures were reviewed on 11/22/10. The policy titled, "Scheduling for Operating Rooms", under "Emergent or Urgent Cases During Non-Routine Hours (Weekends, holidays...)", bullet 6, "The R.N. Circulator on-call will notify the on-call team including the anesthesiologist..."

2. The medical record of Pt. #1 was reviewed on survey date 11/22/10. Pt. #1 was admitted on 1/22/10 with a diagnosis of Gastric Outlet Obstruction and Malnutrition. and was scheduled for a Pyloroplasty. Documentation in the Operative Report on 1/22/10 indicated Pt. #1 "tolerated procedure well." Documentation in the "Consultation Report" indicated that Pt. #1 could not be extubated in the Recovery room and was transferred to the ICU intubated. Documentation in the physician progress notes indicated Pt. #1's condition deteriorated rapidly. Documentation in the physician progress notes on 1/24/10 at 0800 indicated "septic shock worsening, resp. failure persists, belly post-op firm". Documentation in the Event Description indicated Pt. #1 underwent emergency surgery for Abdominal Compartment Syndrome in the ICU because the physician felt she was "too ill to move to OR." Documentation indicated the physician was asked if he wanted anesthesia and indicated he did not need them. Documentation indicated that anesthesia was provided by the ICU nurse with a combination of Versed, Diprivan, and Fentanyl. Documentation indicated Pt. #1 tolerated the procedure remained in critical condition but condition improved.

3. During an interview with the Vice President of Patient Care Services on 11/22/10 at 10:30 AM , it was reported that the "nurse challenged the physician 3 times" regarding the need for anesthesia, but was told he did not need them to be present. During the interview, the above findings were confirmed.

A. Based on record review and staff interview it was determined that the Hospital failed to ensure that Anesthesia is onsite to administer medications to surgical patients in 1 out of 8 surgical records reviewed (pt. #1).

Findings include:


1. The medical record of Pt. #1 was reviewed on survey date 11/22/10. Pt. #1 was admitted on 1/22/10 with a diagnosis of Gastric Outlet Obstruction and Malnutrition. and was scheduled for a Pyloroplasty. Documentation in the physician progress notes on 1/24/10 at 0800 indicated "septic shock worsening, resp. failure persists, belly post-op firm". Documentation in the Event Description indicated Pt. #1 underwent emergency surgery for Abdominal Compartment Syndrome in the ICU because the physician felt she was "too ill to move to OR." Documentation indicated the physician was asked if he wanted anesthesia and indicated he did not need them. The "Nursing Intraop Record" indicated no anesthesia present. Blood administration, vital signs and medications per ICU nurses. Physician's "Operative Report" under Anesthesia: A combination of versed, Diprivan and fentanyl administered under my supervision by the ICU nurse.

2. During an interview with the Vice President of Patient Care Services on 11/22/10 at 10:30 AM, it was reported that the "nurse challenged the physician 3 times" regarding the need for anesthesia, but was told he did not need them to be present. During the interview, the above findings were confirmed.

A. Based on record review and staff interview the hospital failed to have an intraoperative anesthesia record in 1 of 8 surgical records reviewed.

Findings include:

1. The medical record of Pt. #1 was reviewed on survey date 11/22/10 and 12/1/10. Pt. #1 was admitted on 1/22/10 with a diagnosis of Gastric Outlet Obstruction and Malnutrition and was scheduled for a Pyloroplasty. Documentation in the physician progress notes on 1/24/10 at 0800 indicated "septic shock worsening, resp. failure persists, belly post-op firm". Documentation in the Event Description indicated Pt. #1 underwent emergency surgery for Abdominal Compartment Syndrome in the ICU because the physician felt she was "too ill to move to OR." Documentation indicated the physician was asked if he wanted anesthesia and indicated he did not need them. Documentation indicated that anesthesia was provided by the ICU nurse with a combination of Versed, Diprivan, and Fentanyl. The "Nursing Intraop Record" indicated no anesthesia present. Blood administration, vital signs and medications per ICU nurses. The ICU medical record recorded medication administration and vital signs prior to and after the emergency surgical procedure in the ICU. The patient was on ventilator and cardiac monitoring. There was not documentation of any recorded vital signs, oxygenation and ventilation parameters during the time frame of 1755 to 1855 on 1/24/10.

2. During a telephone interview with the Vice President of Patient Care Services on 12/1/10 at 3:00 PM, it was reported that the "ICU nurse was not in Pt. #1 's room during the emergency surgical procedure". During the telephone interview, the above findings were confirmed.