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Based on policy and procedure reviews, medication insert review, open medical record reviews, staff and physician interviews the anesthesia provider failed to complete a postanesthesia evaluation on patients receiving regional anesthesia in 2 of 5 open records reviewed (#10, #2).

The findings included:

Review of policy "Standards of Anesthesia Care" last revised 12/2012 revealed "Standard V Monitor the patient's physiological condition as appropriate for the type of anesthesia and specific patients needs." "Standard VIII A post anesthetic visit shall be made by the anesthesiologist or CRNA on all patients receiving general or regional anesthesia. Interpretation: Inpatients will be discharged from PACU to the patient care unit by a nurse using Medical Staff approved discharge criteria. An anesthesiologist shall write a post anesthetic follow-up note within 24 hours".

Medication insert review revealed Naropin is used for "local and regional anesthesia for surgery". Further review revealed "Peripheral Nerve Block Naropin...ability to provided anesthesia for surgery using the techniques of peripheral nerve block".

1. Medical record review on 2/20/2013 at 1630 of Patient #10 revealed the patient had a surgical procedure of a Left total knee arthroplasty on 2/19/2013. Review of the operative record revealed the surgeon documented "he had a regional followed by a general anesthetic". Review of the Anesthesia Consultation/Evaluation record revealed the anesthesia plan was for general anesthesia with "PN Block (peripheral nerve block", FNB (femoral nerve block), SNB (sciatic nerve block)". Review of the record revealed the patient was administered "ropivacaine and bupivacaine". Record review revealed the surgery started at 1056 and anesthesia stopped at 1428. Record review revealed no documentation of a postanesthesia evaluation after 1515 (48 minutes after anesthesia stopped).

2. Medical record review of Patient #12 revealed the patient had a surgical procedure of a Right total knee arthroplasty on 2/18/2013. Review of the Anesthesia Consultation/Evaluation record revealed the anesthesia plan was for general anesthesia with "PN Block (peripheral nerve block", FNB (femoral nerve block), SNB (sciatic nerve block)". Record review revealed documentation by the physical therapist on 2/19/2013 at 1052 ( approximately 24 hours after surgery) "Pt (patient) eval (evaluation) completed as able with effects of block". Record review revealed no documentation of a postanesthesia evaluation for the recovery of the block.


Interview on 2/21/2013 1025 with Assistant Chief of Staff (anesthesiologist) revealed the anesthesia group is contracted to provide anesthesia coverage for the hospital. The interview revealed the patient would be under the effects of the regional anesthesia (FNB) for approximately sixteen (16) hours. The interview revealed the anesthesia group decided about 5 years ago that anesthetic peripheral nerve blocks would be considered analgesia and not anesthesia. The interview revealed anesthesia providers would not evaluate patients for recovery of the peripheral nerve block and a Physical Therapist would be delegated to evaluate the recovery of the regional block. The interview revealed the group made the changes in the process but was unsure if the changes had been approved by the Medical Executive Committee (MEC). The interview revealed the pharmacy was not involved with the process and change.

Interview with pharmacy administrative staff on 3/21/2013 at 1100 revealed the medication used for peripheral nerve blocks such as "ropivacaine" was considered an anesthetic. The interview revealed the pharmacy department was not aware of the changes with the anesthesia group regarding the use of ropivacaine as an analgesic.

Interview with Compliance administrative staff revealed there was no documentation available in the Medical Staff Bylaws or Rules and Regulation regarding approval of changes about the PNB within the anesthesia department. The interview revealed there was no further documentation of an anesthesia evaluation for the medical records reviewed.


NC00084979
NC00087103