HospitalInspections.org

Based on record review, interview and policy review, Morton County Hospital failed to provide care to patients by an approved provider with medical staff privileges for 1 of 20 medical records reviewed (Patient #4). Failure to credential all providers who oversee patient care in the facility placed all patients at risk for care by an unqualified provider.

Findings include:

- Medical record review on 1/31/2017 at 9:30am revealed Patient #4, DOB 9/31/1960, was admitted on 12/28/2016 as an outpatient with a diagnosis of osteomyelitis. The patient is receiving intravenous (through the vein) (IV) ceftriaxone (antibiotic) twice daily using an established central line that was placed previously. Document review revealed all medication, lab, and IV site orders are written by a physician without facility staff privileges (Physician Staff A).

RN Staff C interviewed on 1/31/2017 at 1:30pm acknowledged Patient #4 "is an outpatient that receives medications, lab, and catheter care per the orders faxed from the outlying physician. All lab results are faxed back to the ordering provider for review. The patient is scheduled to continue with the medication into February. None of our physicians are looking at the orders or overseeing them."

Physician Staff A interviewed on 2/1/2017 at 9:45am confirmed Patient #4 "is a patient of mine that I still see in the clinic. I was treating him before I consulted a specialist for the osteomyelitis. I know that he comes in for rocephin (antibiotic) daily and that the consulting physician is writing all of the orders. They do communicate his/her progress to me. I cannot possibly cosign every order that comes through here. It just isn't possible as there is only me. I know that we need to change our medical staff bylaws so that I am not required to cosign every order."

- "Clinical Privileges" policy reviewed on 2/1/2017 directed "Except as otherwise provided in these bylaws, a member providing clinical services at this Hospital shall be entitled to exercise only those clinical privileges specifically granted. Such privileges and services must be Hospital specific, within the scope of the member's license... ...and shall be subject to the rules and regulations and the authority of the Medical Staff and the Board..."

Based on document review and staff interview the facility failed to ensure that orders were received and documented prior to providing an invasive procedure for 2 of 20 patients (Patient # 16 and 20). This deficient practice had the potential to cause patient harm or death.


Findings include:

- Patient #16's medical record reviewed on 1/30/2017 revealed an admission date of 10/5/2016. The medical record revealed Registered Nurse Staff J documented performing a Foley catheter (tube placed into the bladder for urine drainage) insertion without evidence of an order.

Registered Nurse Staff B interviewed on 2/1/2017 at 11:30 AM acknowledged there is no evidence in the medical record that Registered Nurse Staff J obtained an order prior to inserting a Foley catheter into patient #16.

- Policy titled Urinary Catheter reviewed on 2/1/2017 at 12:30 PM directed "...Urinary catheterization is performed only when a physician determines that there is a specific and adequate medical indication..."

- Patient # 20's medical record review on 1/31/2017 at 8:30 AM revealed a discharge date of 12/28/2016. The facility filed to ensure Physician Staff A signed the order for Venous Thromboembolic Risk Assessment and Order for Prophylaxis.

- Medical Staff Rules and Regulations reviewed on 2/1/2017 at 2:00 PM directed "...All orders, including verbal orders must be dated, timed, and authenticated in written or electronic form..."

Based on record review, interview, and policy review Morton County Hospital failed to provide supervisory oversight of care provided to patients by midlevel practitioners in 3 of 20 medical records reviewed (Patient #14, #17, and #19). Failure to provide supervision put all patients at risk of inappropriate care.

Findings include:

- Patient #14, 49 years old, medical record review on 1/30/2017 revealed he was an emergency department (ED) patient on 9/5/2016 for complaints of severe chest and flank pain. The medical record is incomplete, lacking provider signatures of mid-level oversight within 30 days.

- Patient #17, 32 years old, medical record review on 1/30/2017 revealed he was admitted for observation from the ED on 10/20/2016 with diagnosis of severe tooth pain and seizures. He was dismissed within 24 hours with pain relief and subsided seizures. The medical record is incomplete lacking provider signatures for orders and mid-level oversight within 30 days.

- Patient #19, 81 years old, medical record review on 1/30/2017 revealed she presented to the ED with complaints of epigastric (upper central region of the abdomen) pain. She was admitted for observation with diagnosis of acid reflux (stomach contents move up into esophagus) and renal insufficiency (low urine output). The history and physical at admission lacks both mid-level and physician signature and the medical record is not completed and closed in 30 days.

Physician Staff A interviewed on 2/1/2017 at 9:45am acknowledged "I cannot possibly cosign every order that comes through here. It just isn't possible as there is only me. I know that we need to change our medical staff bylaws so that I am not required to cosign every order."

- "Mid-Level Practitioner Policies" review on 2/1/2017 directed "...The following supervisory procedures will ensure that Physicians provide appropriate oversight of and guidance for all mid-level practitioners... ..All charts will be reviewed, cosigned, and dated within 30 days of the patient's visit..."

Based on document review and staff interview the facility failed to ensure the History and Physical for 4 of 20 patients (# 3, #15,and #9) was completed within 24 hours of admission as directed by facility policy. Failure to ensure the processing of all patients' records in a timely manner has the potential to delay retrieval of the patient's medical information, which could increase their risk for injury or death.


Findings include:

- Patient # 3's medical record review on 1/30/2017 at 3:30 PM revealed an admission date of 1/29/2017. The facility failed to ensure medical staff completed a History and Physical within 24 hours after admission.

- Patient #8's medical record review on 1/31/2017 revealed an admission date of 1/29/2017 and a discharge date of 1/30/2017. The medical record lacked a History and Physical completed within 24 hours of admission.

- Patient # 15's medical record review on 1/30/2017 revealed a discharge date of 12/14/2016. The facility failed to ensure the History and Physical was signed and dated within 24 hours of admission.

- Patient # 19's medical record review on 1/30/2017 revealed an admission date of 12/24/2016 and a discharge date of 12/25/2016. The medical record revealed the facility failed to ensure the History and Physical was signed and dated within 24 hours of admission.

- Medical Staff Rules and Regulations reviewed on 1/31/2017 at 3:45 PM directed "...A complete history and physical examination shall, in all cases be written or dictated, within twenty four hours after admission of the patient..."

Based on document review and staff interview the facility failed to ensure that the discharge summary was signed by the physician staff within 30 days after discharge for 1 of 20 patients (Patient #15). This deficient practice has the potential to increase the risk for inadequate post-hospitalization follow-up care.


Findings include:

- Patient # 15's medical record review on 1/30/2017 revealed a discharge date of 12/14/2016. The facility failed to ensure Physician Staff A cosigned the Discharge Summary documented by Physician's Assistant Staff D and failed to ensure three progress notes were signed within 30 days of the patients discharge from the facility.

Physician Staff A interviewed on 2/1/2017 at 10:10 AM indicated they need to change the Medical Staff Rules and Regulations so they do not have to cosign everything because they are the only physician here and they have too much to do.

- Medical Staff Rules and Regulations reviewed on 1/31/2017 at 3:45 PM directed "... All medical records must be completed within 30 day following the discharge of the patient..."