HospitalInspections.org

Based on document review and interview the facility did not comply with all of the provisions for conducting a medical screening exam. Please reference findings under Tag 2406.

Based on interview and document review the facility did not provide a complete medical screening exam for 1 of 8 patients who presented to the Labor and Delivery (L&D) unit for emergency medical care (Patient #1). Failure to conduct a complete medical screening exam could result in an emergency medical condition not being identified and treated.

Findings include:

Review of the OB/GYN Triage Report dated 08/17/17 at 09:15 PM revealed Patient #1 presented at 22 weeks gestation to the Obstetrical unit with complaints of spotting and cramping for two days. Pain level was described as 4-6 (1-10 scale, 10 the most pain). Patient #1 was unknown to the facility. The fetus was noted to be active with a fetal heart rate (FHR) of 155 (nl 110-160) with intact membranes and no palpable contractions.

Review of the Nursing Detailed Notes Log dated 08/17/17 at 09:20 PM noted that the nurse was unable to reliably place the tocometer to measure potential contractions. At 09:50 PM the nurse contacted Staff (F), OB/GYN provider regarding Patient #1's assessment. Staff (F) asked the nurse to complete a gentle vaginal exam which revealed a soft, anterior cervix with 0.5cm dilation and intact membranes. Staff (F) stated that Patient #1's pain was likely cramping from constipation and dehydration and asked the nurse to see if Patient #1 was agreeable to going home and trying a suppository. At 10:30 PM, Patient #1 was discharged to home without receiving a medical screening by a physician.

Review of the ED record dated 08/18/17 at 03:33 AM revealed Patient #1 returned to the ED after delivery of a non-viable infant at home.

Review of the OB on-call schedule for August 2017 revealed Staff (F), OB/GYN was on-call for OB/GYN on 08/17/17.

Interview with Staff (F), OB/GYN physician on 10/24/17 at 11:30 AM revealed he did not come in to evaluate Patient #1 during her initial visit on 08/17/17 because he spoke to the RN and felt that her symptoms were not unusual.

Interview with Staff (D), RN on 10/24/17 at 01:35 PM revealed if the obstetrical providers are not on campus and an unknown patient presents to Labor and Delivery, the on-call provider is expected to come into the hospital to evaluate the patient. RN's are not to conduct vaginal exams on pre-term patients less than 34 weeks gestation.

Review of the policy "Admission to the Emergency Department: Medical Screening" last revised 09/16/14 indicates all unscheduled emergency patients will be evaluated, treated, admitted, discharged or transferred by a physician.

Review of the policy "Obstetrical Triage and Treatment in the Emergency Department" issued 07/01/2017 indicates pregnant patients more than 20 weeks gestation shall be transferred to L&D for further evaluation and care. The admitting obstetrician or the on-call medical staff gynecologist shall be responsible for the patient evaluated in L&D.

Review of the policy "Premature Labor, Protocol For" last revised 11/16/16 revealed all patients verbalizing symptoms of premature labor will be instructed to report to the Obstetrical unit for assessment and be placed on the fetal monitor. The provider will evaluate the patient and review the electronic fetal monitor.