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Tag No.: A2406
Based on review of documents provided by the facility, it was determined the facility failed to ensure all patients presenting to the Emergency Department were provided with a medical screening examination.
Findings include:
MR1, a 36-year-old patient, presented to the Emergency Department (ED) on August 5, 2016, at 6:55 PM. The patient presented to the women's hospital triage department with concerns over continued bleeding and progression of pending miscarriage (at six weeks gestation) that she was diagnosed with earlier in the day. The patient was registered and escorted to a treatment room in triage. The PA was the first clinical staff member to see the patient. The PA contacted the Attending OB, and the patient then left without receiving a medical screening exam. After the administrator was advised of the event on August 8, 2016, then patient was contacted and requested to return to the hospital for an exam, which did occur.
The facility immediately institute the following plan of corrective action:
Immediate Action:
Upon investigation of this event, a review was conducted by the Clinical Director of Regulatory Readiness, the Vice President of Nursing, the Vice President of Medical Affairs, and the Magee-Womens, UPMC Hamot Hospital Director of Labor and Delivery. A plan was created to address the identified deficiency ensuring that the patient who did not receive a medical screening examination returned to the hospital and was fully examined and evaluated for an emergency medical condition.
Completed: August 8, 2016
Personnel Issue:
The UPMC Hamot Medical Staff and Human Resources investigated the Physician Assistant that omitted a medical screening examination. The guidance provided in the UPMC Hamot Medical Staff Bylaws and Human Resource policies and procedures governed the investigation which resulted in administrative suspension of employment and privileges. Administrative suspension was enacted based on documentation discrepancies and a series of recent non-conforming practices in addition to the EMTALA event. During suspension, the employee resigned her position.
Completed: August 15, 2016
Education:
Education concerning EMTALA and the need for a medical screening exam is completed as an annual competency requirement. This education will be repeated to Magee-Womens, UPMC Hamot clinical nurses, nursing assistants, unit secretaries, health unit coordinators, and registration staff, physicians, and physician assistants by u-learn or University of Pittsburgh Internet-based Studies in Education & Research (ISER).
Re-education concerning the requirement of UPMC Hamot policy entitled, " Chain of Command for Reporting and Resolving Concerns Over Patient Care " . This education will be for Magee-Womens, UPMC Hamot clinical nurses, nursing assistants, unit secretaries, health unit coordinators, and registration staff.
Completion date: September 15, 2016
Monitoring:
The Director of Women Services and/or their designee will randomly audit 15 registrations to the Magee-Womens, UPMC Hamot triage per week to ensure that a medical screening exam was performed.
Audits will begin the week of September 4, 2016, and will be completed on October 22, 2016.
The Director of Women Services and/or their designee will review the audit results with the Vice President of Medical Affairs and the Patient Safety and Quality Committee of UPMC Hamot. Appropriate action for identified issues will be taken.
A compliance rate of 100% is required for the completion of a medical screening examination.
Completion Date: November 16, 2016.
The person responsible for overseeing the correction of this deficiency will be the Vice President of Patient Care Services.