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181 CORLISS LANE

COLEBROOK, NH 03576

STABILIZING TREATMENT

Tag No.: C2407

Based on record review and interview the facility filed to ensure that all patients are appropriately stabilized prior to transfer for one patient in a survey sample of 30 patients

Findings include:

During an Emtala survey on 11/5/12 record review identified that patient A was seen in the ED (Emergency Department) on 10/17/12.The patient had been brought to the ED by a local ambulance service which had responded to the individuals home earlier that night at 8:55 P.M.. The ambulance service had received a 911 Emergency call at approximately 8:46P.M. They responded to find the individual by report " unresponsive w / agonal respirations, skin cool / diaphoretic. Copious vomitus present " , " Narcan (Drug Antagonist) admin intra-nasally " . The ambulance departed the individual ' s home at 9:14 P.M. and arrived at the ED at 9:16 P.M. " Pt. released to ED staff bed B, RN, DR at bedside. "
Review of the ED record indicates that treatment began at 9:18 P.M. Treatment included cardiac monitoring and oxygen saturation (The amount of oxygen in the blood) monitoring at 9:18 P.M. Portable X ray at " 21:10 " (9:10 P.M.), blood work drawn at 9:25 P.M., IV medications administered (anti-biotic, anti- nausea and Benadryl at 9:31 P.M.) and arterial blood gases drawn at 9:40 P.M.
Review of the blood gas results indicated a high value for percentage of carbon dioxide at 57 (Normal range 33-47), and a low value for percentage of oxygen at 62 (Normal range 95-100). Phone Interview with Staff A (Emergency room physician) on 11/13/12 confirmed that he was aware of these values. Review of the facility protocols for management of drug overdose patients in the ED indicated that a urine toxicology screen be obtained. Review of the medical record for Patient A showed no evidence that the urine toxicity screen had been obtained. Interview with Staff A identified that the patient had stated when questioned about having ingested any type of drugs that the patient responded, " I am an alcoholic but I have not taken any drugs "
During interview with Staff A on 11/13/12 it was identified that he was aware of patient A receiving Narcan during their treatment by the ambulance service earlier that night and indicated that he was " taking the patient on his word " about the use of drugs
Review of the results of the chest X-ray taken during the ED treatment showed right lobe infiltrates and an air distended esophagus, which the interview with Staff A confirmed. Interview (Phone) with Staff A and Staff B (Registered ED Nurse) indicated that Patient A was alert and orientated during his stay at the ED while awaiting transfer. Interview also identified that Patient A was conversing with his mother in the ED during this time.
Review of the ED record indicated under the section " PRIMARY ASSESSMENT " that Patient A was checked off (Indicating Normal) under " neuro awake alert " . In the " SECONDARY ASSESSMENT " section under " neuro " Patient A is checked off as being " orientated x4 "
Documented notations on the paperwork sent from the intermediate hospital where the transfer diverted to on route to receiving facility indicated that Patient A " Was talking at hospital " (At originating facility)
During interview on 11/13/12 with Staff A They stated that after " reviewing the bloodwork, gases, and chest X-ray " , he felt that he needed to be in a facility that had more " intesivists " he called the destination facility and spoke with a physician who accepted the transfer and the Patient was transferred at 11:10 P.M. Review of the Transfer Certification paperwork identified that the " Consent to Transfer " section had not been signed by the Patient or legally responsible party.
Review of the ambulance service paperwork showed documentation that the patient went into Respiratory arrest around " 1.5 " hours into the trip and the ambulance diverted to the intermediate facility where the patient was stabilized and transferred to the original destination facility.