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Based on interview and documentation review, it was determined the Hospital's Internal Investigation related to Patient #1's ED care did not:
1.) assess the ED's compliance with the American Heart Association's (10 minute) time guideline for obtainment of EKGs on patients with cardiac symptoms/possible cardiac symptoms.
2.) identify a documentation deficiency related to medication administration.

Findings included:

A review of the Hospital Internal Investigation related to Patient #1's ED care revealed the Patient's medical record and ED policies and procedures were reviewed, ED staff involved in the Patient's care were interviewed, and the Investigation determined: a pre-hospital EKG performed on the Patient revealed a STEMI (ST-segment elevation myocardial infarction [heart attack]); EMS (Emergency Medical Service) personnel inappropriately transported the Patient to the Hospital instead of Hospital #2 (where PCI [percutaneous coronary intervention] is available); the pre-hospital EKG was handed to an ED triage nurse (Triage Nurse #1); the Patient's Triage Assessment did not mention the STEMI; the pre-hospital EKG/STEMI was not communicated to an ED physician; an ED EKG was not performed until 29 minutes after the Patient's arrival (well outside the 10-15 minute goal); the ED EKG was different from the pre-hospital EKG likely due to lead misplacement; the ED EKG was abnormal, but did not show ST elevations inferiorly; the ED physician who reviewed the ED EKG consulted with an interventional cardiologist at Hospital #2; the Interventional Cardiologist recommended that the Patient be transferred to Hospital #2 for cardiac catheterization/PCI and; the Patient was transferred to Hospital #2.

The Hospital Internal Investigation did not determine the ED's level of compliance with the American Heart Association's (10 minute) time guideline for the obtainment of EKGs on patients with cardiac symptoms/possible cardiac symptoms and/or identify that Integrilin (a medication that inhibits blood coagulation) ordered for Patient #1 was not administered or cancelled (secondary to the Patient's immediate transfer).

Based on documentation review, it was determined the Hospital had not (yet) fully implemented a Corrective Action Plan related to its Internal Investigation of Patient #1's ED care.

Findings included:

Please see Tag A 287 for information related to the Hospital's Internal Investigation of Patient #1's ED care.

A review of the Corrective Action Plan related to the Hospital's Internal Investigation of Patient #1's ED care revealed it called for: Triage Nurse #1 to be counseled; ED Registered Nurse (RN) staff education regarding follow-up on pre-Hospital EKGs and; Clinical Assistant (CA) staff education/competency validation regarding the performance of EKGs.

A review of the Corrective Action Plan implementation revealed: Triage Nurse #1 had been counseled; ED RN staff education regarding follow-up on pre-Hospital EKGs had not (yet) occurred and; CA staff education/competency demonstration regarding the performance of EKGs was underway, but not completed.