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Based on record review and staff interview the facility failed to ensure the doctor of medicine or osteopathy in conjunction with the nurse practitioner, preformed a face-to-face periodic review the clinic patient records of the Clarinda Medical Clinic. The clinic staff identified 748 of 1600 clinic visits per month were completed by a nurse practitioner.

Failure to review the nurse practitioner patient medical records with the overseeing medical doctor inhibits the facility's ability to determine the quality of care provided to the CAH patients.

Findings include:

During an interview on 5/21/12 at 1:55 PM, Staff F, Director of Clinics, acknowledged the lack of a periodic face to face interview between the medical doctor or doctor of osteopathy and the nurse practitioner of the clinic patient records. An additional interview on 5/22/12 at 10:20 AM, Staff E, Director of HIM (Health Information Management) acknowledged the lack of a periodic face to face interview between the medical doctor or osteopathy and the nurse practitioner of the clinic patient record.

The following documents lacked evidence the periodic face to face interview and record review between the medical doctor or osteopathy and the nurse practitioner had occurred: Medical Staff Rules and Regulations 1/12-5/12 Medical Staff Meeting Minutes Clinic policies and procedures 1/12-5/12 Quality Assurance Meeting Minutes.

The 2010 Annual Program Review revealed, in part... " Mid-level providers who provide services in the Emergency Department are reviewed monthly by physicians with a face-to-face meeting for questions and comments. A 10% sample is reviewed each month for each mid-level provider. " The Annual Program Review lacked information regarding the face-to-face interview between the Mid-levels and the physicians of the clinics patient record.

Based on record review and staff interview, the facility failed to ensure the doctors of medicine or osteopathy, in conjunction with the nurse practitioner, periodically reviewed the clinic patient's records at the Clarinda Medical Clinic. The clinic staff identified 748 of 1600 clinic visits per month were completed by a nurse practitioner.

Failure to review the nurse practitioner patient medical records with the overseeing medical doctor inhibits the facility's ability to determine the quality of care provided to the CAH patients.

Findings include:

During an interview on 5/21/12 at 1:55 PM, Staff F, Director of Clinics, acknowledged the medical doctor or doctor of osteopathy failed to review clinic patient's records with the the nurse practitioner. During an additional interview on 5/22/12 at 10:20 AM, Staff E, Director of HIM (Health Information Management), also acknowledged the lack of clinic patient's records reviewed by the medical doctor or doctor of osteopathy and the nurse practitioner.

The following documents lacked evidence of that a periodic review of the clinic patient records by the medical doctor or osteopathy and the nurse practitioner had occurred: Medical Staff Rules and Regulations 1/12-5/12 Medical Staff Meeting Minutes Clinic policies and procedures 1/12-5/12 Quality Assurance Meeting Minutes all lacked documentation showing a periodic review of clinic patient's medical records had occurred.

The Annual Program Review lacked information regarding a review of the clinic patient's records.

Based on facility policies, observation and staff interviews, the staff of the Infusion Center, Therapy department and Clarinda Medical Clinic failed to secure confidential patient medical records from unauthorized users in their departments (Infusion center, Physical/Occupational/Speech therapy department and Clarinda Medical Clinic).

The Infusion Center staff reported an average of 44 procedures a month.
The (Speech/Physical/Occupational) Therapy Department reported an average of 60-80 patients a week.
The Clarinda Medical Clinic reported an average of 1600 patients per month.

Failure to secure patient's medical records could potentially result in access to patient information by unauthorized users.

Findings include:

1. Review of the policy, "Security/Confidentiality of patient Medical Record" initiated 1/16/12 revealed in part, "It is the policy of Clarinda Regional Health Center that the patient medical records are maintained in a secured and confidential manner. Areas housing heath information shall be restricted to authorized personnel..."

2. Tour of the Clarinda Medical Clinic on 5/21/12 at 12:30 PM revealed:
a. Three large open blue recycle bins located on the outside of the nursing station, each bin contained papers with patient information including but not limited to patient names, date of birth, address, phone number, medical record number, diagnosis and treatment.

b. Two smaller open blue recycle bins located under the nursing station, each bin contained papers with information including but not limited to patient names, date of birth, address, phone number, medical record number, diagnosis and treatment.

c. One small open blue recycle bin located in the Clarinda Medical Clinic room labeled "Lab", the bin contained papers with information including but not limited to patient names, date of birth, address, phone number, medical record number, diagnosis and treatment.

d. During an interview, at the time of the observation, Staff A, unit secretary, stated the information would be put on the computer then the paper would be placed in the blue recycle bin. Staff A stated housekeeping staff cleans the area after hours without supervision and maintenance picked up the papers with a locked bin once a week and removed them from the area.

Staff B, Director of Clarinda Medical Clinic, acknowledged housekeeping staff cleans the department and lab area after hours and would have access to the patient information on the papers contained in the open blue recycle bins.

Tour of the Speech/Physical/Occupational Therapy department on 5/16/12 at 2:50 PM revealed:
a. An open blue recycle bin behind the reception desk, the bin held papers with patient information including but not limited to patient names, date of birth, address, phone number, medical record number, diagnosis and treatment.

b. During an interview at the time of the observation, Staff C, Physical Therapy Assistance, stated housekeeping staff cleans area after hours without supervision and maintenance picked up the papers with a locked bin once a week and removed them from the area.

Tour of the Infusion department on 5/16/12 at 2:45 PM revealed:
a. An open blue recycle bin next to the shredder behind the nursing station, the bin held papers with patient information including but not limited to patient names, date of birth, address, phone number, medical record number, diagnosis and treatment.

b. During an interview at the time of the observation, Staff D, Infusion Registered Nurse, stated housekeeping staff cleans area after hours without supervision and maintenance picked up the papers with a locked bin once a week and removed them from the area.

3. During an interview on 5/22/2012 at 10:45 AM, Staff E, Health Information Manager (HIM) stated she understood the housekeeping staff did not clean the departments after hours. Staff E stated the housekeeping needed to be supervised when cleaning areas that have the blue recycle bins. Staff E stated the blue recycle bins are throughout the hospital, and then acknowledged if housekeeping cleans the area after hours they would have access to the patient information on the papers in the bins. Staff E acknowledged housekeepers are not authorized personnel for patient information.