HospitalInspections.org

Based on document review and staff interview it was determined the hospital failed to ensure the Emergency Department had policies and procedures in place for the care and treatment of patients receiving outpatient services/procedures in the Emergency Department. This failure has the potential to negatively impact the care provided to all outpatients in the Emergency Department.

Findings include:

1. Review of the Rural Health Clinic medical record for Patient #1 revealed a visit was documented for 9/21/17. The medical record revealed the patient to be an eighty-seven (87) year old male who was a nursing home resident. He was seen in the clinic at approximately 11:11 a.m. for complaints of altered mental status and shortness of breath. Documentation of a chest x-ray revealed left basilar infiltrate and documentation of laboratory results revealed leukocytosis. Further documentation states, "Family was contacted during this exam and they are agreeable for him to be transferred to the VA Medical Center in Clarksburg, West Virginia for further evaluation as he is a VA contract. Patient was placed on oxygen here in the clinic titrated up to approximately 4 L via nasal cannula which improved his sats in the upper 80s or 90s." Further review of the medical record revealed the section titled "Medications" states, "Patient sent to ER for one-time dose of Lasix 40 mg IV, Vancomycin 1 g IV, DuoNeb breathing treatment x's 1, blood cultures x's 2 sets."

2. An interview was conducted on 10/10/17 at 9:05 a.m. with the Registered Nurse (RN) /ED Charge Nurse. During the interview she stated, "It is not unusual for the clinic to send a patient to the ED as an outpatient for an IV and/or IV fluids.

3. Review of the ED Policy and Procedure Manual revealed no ED Policies and Procedures could be located for care and treatment of patients receiving outpatient services/procedures in the ED.

4. On 10/10/17 at 12:30 p.m. the Director of Nursing(DON)/ ED Nurse Manager confirmed there were no written ED policies and procedures for patients receiving outpatient services/procedures in the ED.

5. An interview was conducted on 10/10/17 at 2:24 p.m. with the Medical Director of the Emergency Department. During the interview he stated, "It is common practice for the clinic to send patients to the ED for outpatient IV therapy." During this interview he confirmed there were no ED policies and procedures for patients receiving outpatient services/procedures in the ED.

6. An interview was conducted on 10/10/17 at 1:05 p.m. with the Chief of Medical Staff. During the interview he confirmed there were no ED policies and procedures for care and treatment of patients receiving outpatient services/procedures in the ED.