HospitalInspections.org

Based on record review and interview the facility failed to enforce the medical staff bylaws for one of 30 (#1) records reviewed . The on call surgeon did not respond within the 45 minutes to one hour specified by the medical staff bylaws. Failure to enforce medical staff bylaws may lead to inconsistent care.

Findings:

Review of the medical record for patient number 1 reveals that the patient presented to the emergency department with abdominal pain and that on exam the patient had tenderness. A computed tomography (CT) scan was completed and was positive for appendicitis. The record also reveals that on 2/12/2010 at 20:30 (8:30 PM) that the emergency room physician called the on call surgeon concerning the patient. Review of the informed consent signed by patient number 1 on 2/13/2010 at 12:49 (PM) reveals that it was not signed by the physician. Review of patient number one's medical record reveals that the patient had anesthesia started at 14:34 (2:34 PM) on 2/13/2010.

Interview with the Chief Nursing Officer on 3/03/2010 at 2:30 PM reveals that the nursing staff had attempted to contact the on call surgeon multiple times to see patient number 1 without success. She further stated that the case manager had alerted her to the situation and that the Chief of Surgery had been notified. She also stated that shortly after the Chief of Surgery was contacted the Surgeon arrived at the hospital and made arrangements for surgery. She further stated that the hospital only performs emergency surgery on the weekend.

Review of the medical staff bylaws for Putnam Community Medical Center with an approved date by the board of trustees of 12/8/2007, and an approved date by the medical staff of 11/20/2007 reveals that "After discussion with the Emergency Department physician, on-call physician shall come to the emergency department to see patient if requested within 45 minutes to 1 Hour. The bylaws also state that "a staff member with patients in the hospital should be available within reasonable response time."

An interview with the Medical Director of the emergency department was conducted on 3/3/2010 at 2:40 PM and he stated that a reasonable response time would be one hour. He stated that it would be the expectation that in the case of a patient with documented tenderness and positive CT results that the surgeon would respond and 12 hours is a long time and 15 hours is a very long time to wait to get the patient to surgery.

Based on record review the facility failed to ensure that verbal orders are authenticated by the physician within 48 hours for 3 of 30 patients' records reviewed (#1, #2, #3.) The failure to ensure that all verbal orders are authenticated within 48 hours has the potential to allow care that is not directed by the physician.

Findings:

Review of the medical record for patient number 1 reveals a telephone order for normal saline intravenously (IV) at 125 hour (1:25 PM), zosyn 3.375 IV q6 [every 6] hours, Zofran 4 milligrams (mg) IV q4 hours PRN[as needed] N/V, Morphine 4 mg IV q4 hours prn pain,and Toradol 30 mg IV q6 hours routinely on 2/13/2010 at 10:20 (AM) and was not signed by the physician as of the date of the survey (3/3/2010).

Review of the medical record for patient number 2 reveals a telephone order for Flagyl 500 mg IV Bid [twice a day] X [times] 7 days on 2/16/2010 at 2000 (8:00 PM) and was not signed by the physician as of the date of the survey.

Review of the medical record for patient number 3 reveals a telephone order for Invanz (Not Primaxin) and hold Premarin dated 2/17/2010 at 12:30 (PM) was not signed by the physician as of the date of the survey. The record also reveals a telephone order for hold Primaxin, hold azithromycin, atarax 25 mg PO [by mouth] 1 x only now dated 2/16/2010 at 00:45 (12:45 AM) was not signed by the physician as of the date of the survey. The Record also reveals a telephone order for Mag Oxide 400 mg PO q12 hours, KDur 20 milliequivalent (meq) now and dated 2/16/2010 at 14:26 was not signed by the physician as of the date of the survey. The record also reveals a telephone order for Benadryl 25 mg PO q6 Hours PRN/itching give moisturizing lotion dated 2/15/2010 at 2000 was not signed by the physician as of the date of the survey.

Based on record review and interview the facility failed to ensure that for one of 30 patients' records reviewed (#1) a properly executed informed consent was on the chart prior to surgery. The failure to ensure a properly executed informed consent prior to surgery has the potential to allow improper surgery.

Findings:

Review of the informed consent for patient number 1 reveals that it was not signed by the physician.

During Interview with the Chief Nursing officer on 3/3/2010 at 2:30 PM she confirmed that the consent is not sign by the physician.