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Based on reviews of medical records, policies and procedures, list of Obstetrical nurses, Obstetrician On-Call schedule and interview the facility failed to ensure that medical screening examinations were conducted by individuals(s) labor and Delivery Registered Nurses (Obstetrical Nurses) who were determined qualified by the hospital by-laws or Rules and Regulations and did not have competency evaluations completed to perform medical screening examinations for labor and delivery patients 17 Labor and Delivery nurses.
Findings:
Merit Health Medical Staff Rules and Regulations, Revised 3/23/2015 were reviewed. The Rules and Regulations specified in part, " 5.3 EMERGENCY MEDICAL SCREENING OF WOMEN IN LABOR: When a pregnant female presents to the Emergency Department, she will be assessed by the triage nurse (R.N.) to determine whether the presenting complaint is onset of labor or a general other complaint, not of onset of labor. Patients at term (defined as 37 or more weeks gestation), determined to be complaining of labor onset and not suffering from any apparent complications, will be transported to the Labor and Delivery Unit with qualified medical personnel. All other pregnant females presenting to the Emergency Department, whether complaining of preterm labor or presenting other complications will be medically screened and treated as provided in Article VI of these Rules and Regulations. For those patients at term are referred to the Labor and Delivery Unit, an RN trained in obstetrics will initiate the orders of the obstetrician of record, or in the case of a patient presenting with no prenatal care or care by a physician who is not a member of the Medical Staff, the orders of the physician on-call for obstetrics. For patients at term without other complications, the medical screening examination required under article VI may be performed by a quailed R.N. under the orders of and in telephone contact with the obstetrical physician. " The hospital ' s " Article VI EMERGENCY MEDICAL SCREENING, TREATMENT, TRANSFER & ON-CALL ROSTER POLICY ' was reviewed. The policy indicated in part, " 6.1 (a) Screening : ...(3) All patients shall be examined by qualified medical personnel which shall be defined as a physician or in the case of a women in labor, a registered nurse trained in obstetric nursing. "

The hospital ' s Labor and Delivery (L & D) RN ' s (Registered Nurses) list was reviewed. The list included the Nurse Manager of the L&D unit, Eleven (11) Registered Nurses, One (1) RN specialty, and four (4) Staff RN-PRN (as needed).

Review of the Competency form dated 6/4/2015 for the Nurse Manager, revealed in part, Central Mississippi Medical Center (now Merit Health Central) requires that all L&D and OB/GYN RNs be competent in screening and or triaging all patients presenting in active labor or potential labor. Provide an appropriate medical screening examination while the capability of the hospital ' s emergency department, including ancillary, Obstetrics, and Labor and Delivery routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The competency was validated by the Chief of the OB Department.

The policy titled, " Admission Routine L&D (labor and Delivery) Code Number 100, Reviewed/Revised, 04/11 was reviewed. The policy indicated in part. 3. Place patient on Fetal Heart Monitor ...8. A sterile vaginal exam (examination) is performed by the nurse on patients that are 37 weeks or greater. Observe for presence and amount of bloody show, whether or not membranes are intact, dilation, effacement, station of presenting part. Document findings.9. Call patient ' s as soon as possible to alert hem/her of patient ' s status and obtain orders. VARIATIONS: 1. If delivery is imminent, there will be variations in the procedure. If at all possible, vital signs and any allergies should be obtained prior to delivery. 2. Admission of non-laboring patients is essentially the same except there will be no vaginal exam unless specifically ordered by the physician.
An interview was conducted with the L & D Unit Manager on 6/5/2015 at A0:00 a.m. The Unit manager stated that competency evaluations for the Obstetrical Nurses that were performing MSE on the obstetrical patients were not yet complete. The L&D Unit Manger also stated that the OB nurses were not yet approved by the Board of Trustees to perform Medical screening examinations on Obstetrical patients. There were no competency forms for L&D and OB/GYN RNs to review to validate that the Eleven (11) Registered Nurses, One (1) RN specialty, and four (4) Staff RN-PRN (as needed) had received competency training in OB to provide medical screening examinations for OB patients presenting to the ED and/or L&D unit.
The facility failed to ensure that the Rules and Regulations were followed as evidenced failing to ensure that the OB RN ' s were trained to perform MSE as listed in the hospital's Medical Staff Rules and Regulations.