HospitalInspections.org

Based on observation, interview and record review, the facility failed to ensure that surgical services be consistent with the patient's needs and assure that the resources related to patient care requirements specific to preoperative work-up and safety practices are met in one (SP#3) of 34 sample patients.

The findings include:

Observation conducted on 9-21-11 at 250pm revealed Sample Patient (SP)#3 was in room 402, the facility's pre-testing suite. Sampled patient SP#3 was observed on two stretchers with a backboard perpendicular at the foot part for additional support. Further observation showed SP#3 in no distress, in a patient's hospital gown with a dressing over the previously removed intravenous access.

Interview with SP#3's surgeon conducted on 9-23-11 at 330pm revealed that he is the only surgeon who is presently performing gastric bypass procedures in the facility. He confirmed that SP#3 failed to come for his last preoperative examination at his office scheduled three weeks prior to surgery. He also confirmed that he last examined SP#3 approximately nine months ago. He also reported that patients should be evaluated by their surgeon at least a month prior to the planned surgical procedure. He then reported that SP#3 is not a candidate for this facility and that SP#3's surgery was ultimately canceled because the Operating Room (OR) table can only accommodate up to 400 pounds. He also confirmed that SP#3's health status had changed from the last time he evaluated him. He added that SP#3 is not presently a candidate for bariatric surgery.

Interview with the Pre-testing Charge Nurse conducted on 9-22-11 at 1122am revealed that she got SP#3 ready for surgery by completing the preoperative paperwork and starting the intravenous access. She stated that she noted SP#3's weight documented as 477 pounds on the form titled "Reservation Memo" from the Pre-testing department dated 9-12-11. She reported that SP#3 presented himself to the Pre-testing department on 9-21-11 via an ambulance service on a stretcher. She added that various staff members assisted in getting SP#3 onto two of the facility stretchers with blankets in the middle of the stretchers and a backboard at the foot part for additional comfort and support. She also confirmed that the Operating Room (OR) Manager informed her later in the preoperative process that the OR table could only accommodate up to 400 pounds. She further stated that the surgery was subsequently canceled, intravenous access discontinued and SP#3 allowed to have clear liquids. She confirmed that the surgeon informed the patient and his family regarding the cancellation of the procedure.

Interview with the OR Manager conducted on 9-27-11 at 12noon revealed that patients scheduled for Bariatric Surgery go through the Pre-Admitting department located on the facility's fourth floor. He explained that SP#3's pretesting records were faxed into the Pre-Admitting department. He stated that checks and balances were done for SP#3. He then added that he notified SP#3's surgeon about SP#3's present weight and health status. He also confirmed that after SP#3 was seen by the surgeon, the scheduled surgery was eventually canceled. He added that both SP#3 and his father were made aware of the canceled surgery and the factors that led to it. He continued to say that as of 9-26-11, the facility will have an OR table that could hold up to 1000 pounds.

Review of facility Policy and Procedure titled Bariatric Surgery conducted on 9-22-11 included but not limited to: "Bariatric Surgery is an elective procedure that must be scheduled with the pre-admitting department. Criteria for bariatric surgery: 1) The patient must weigh 400 pounds or less; 2) The patient must be medically cleared for the procedure."