HospitalInspections.org

Based on record reviews and interviews, the hospital failed to ensure the patient right to receive care in a safe setting. This deficient practice was evidenced by failing to ensure a first year surgical resident was under direct supervision by the supervising physician during an incision and drainage procedure that resulted in severe pain for 1 (#1) of 3 (#1-#3) sampled patients.
Findings:

Review of the hospital Graduate Medical Education: Resident Supervision policy revealed, in part:
I. Purpose: To ensure that sponsored residency programs provide appropriate supervision to residents in accordance with the ACGME Institutional and Common Program Requirements.
III. Policy Statements. A. Each sponsored, accredited residency program will develop criteria and procedures which specify that residents are provided with progressively increasing responsibility for patient care according to their level of education, ability, and experience. These criteria must specify the extent to which residents may undertake patient without direct supervision. The program must use the following classifications of supervision:
1. Direct Supervision: the supervising physician is physically present with the resident and patient.
B. PGY 1-residents should be supervised either directly or indirectly with direct supervision immediately available. PGY-1 residents should be supervised directly until the resident has demonstrated sufficient competence to progress being supervised indirectly with direct supervision available.

Review of the hospital residency program General Surgery Levels of Care documentation revealed, in part:
Supervision: Direct-the supervising physician is physically present with the resident and patient. Further review revealed, in part, for drain abscess procedure a PGY-1 resident required direct supervision by the supervising physician.

Review of Patient #1's medical record revealed an admit date of 11/09/2023. Patient #1 had the diagnosis of left groin abscess and scheduled for bedside incision and drainage procedure.

Review of Patient #1's medical record revealed the patient had a bedside incision and drainage done on 11/10/2023 by S3MD, PGY-1 surgical resident. There was no evidence S3MD, PGY-1 had direct supervision by a supervising physician during the procedure.

Review of Patient #1's nurses notes revealed pain level at "10" during the procedure.

Review of the hospital Pain Assessment policy revealed, in part:
Pain intensity will be measured using the 0 - 10 scale or Wong-Baker Faces. The pain scale includes numbers and a description of how to describe each patient's pain. i.e., 7 - 10= severe pain. Further review revealed a Universal Pain Assessment Tool with pain level 10= worst pain possible.

In an interview on 12/28/2023 at 11:07 a.m., S4RN confirmed she was the Charge Nurse on 11/10/2023 when Patient #1 had an incision and drainage of left groin abscess done at bedside. S4RN confirmed the incision and drainage was performed by S3MD, PGY-1 surgical resident. S4RN confirmed she was informed by S5RN of the patient's severe pain and spoke with S3MD, PGY-1 resident about stopping the procedure due to the inability to adequately control the patient's pain at bedside. S4RN confirmed Patient #1 was in severe pain. S4RN confirmed S3MD, PGY-1 surgical resident did not have a supervising physician physically present with the resident and patient during the procedure.

In an interview on 12/28/2023 at 12:56 p.m., S1VP Regional CNO confirmed the hospital Graduate Medical Education: Resident Supervision policy for incision and drainage procedure (drain abscess) required PGY-1 surgical residents to be under direct supervision with the supervising physician physically present with the resident and patient during the procedure. S1VP Regional CNO confirmed this was not done for Patient #1's left groin abscess incision and drainage procedure on 11/10/2023.

In an interview on 01/03/2024 at 9:28 a.m., S5RN confirmed she was Patient #1's nurse on 11/10/2023 when Patient #1 had an incision and drainage of left groin abscess done at bedside. S5RN confirmed the incision and drainage was performed by S3MD, PGY-1 surgical resident. S5RN confirmed Patient #1 was in extreme pain and wanted to stop the procedure and have the procedure done in surgery and under sedation. S5RN confirmed she informed S4RN, Charge Nurse who intervened and the procedure was stopped. S5RN confirmed S3MD, PGY-1 surgical resident did not have a supervising physician physically present with the resident and patient during the procedure.