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Based on observation, document review and interview, the critical access hospital (CAH) failed to ensure that 4 of 10 patient rooms(122, 123, 124 & 108) had a functioning ventilation systems.

Findings include:

During the environmental tour on 8/21/13 at 9:00 a.m., it was discovered the air handling systems in 4 of 10 patient rooms (122, 123, 124 and 108) were not working. The manager of plant operations, present during the tour, stated he had not been aware of this problem.

In an interview with the maintenance technician on 8/21/13 at 12:42 p.m., he said he thought these air handling systems had been checked in either January or February of 2013 and had been found to be in working order.

The Preventative Maintenance Schedule Policy with latest revision 10/04, indicated: "It is the policy of Tyler Healthcare Center that a regular preventive maintenance program is in place to assure a safe environment and safe patient care delivery." The policy further indicated that exhaust system were to be checked quarterly.

In an interview with the plant operations manager on 8/21/13 at 10:15 a.m., he verified these rooms had been regularly occupied by patients since January or February 2013, and stated he would have the problem fixed immediately.

Based on document review and interview, the critical access hospital (CAH) failed to ensure a post-anesthesia evaluation had been conducted by the certified registered nurse anesthetist (CRNA) for 2 of 4 (P1 and P2) patient records reviewed.

Findings include:

It was noted during record review that the post-anesthesia evaluation was lacking for P1, who had general anesthesia administered on 4/18/13, during an exploratory laparoscopy. In addition, P2 had general anesthesia administered on 1/7/13, during a laparoscopy cholecystectomy. The post-anesthesia evaluation was lacking for P2.

During interview with the surgical director on 8/20/13 at 4:00 p.m., she confirmed the post-anesthesia evaluations were lacking in the documentation reviewed for both of these records. The surgical director stated the CAH policy had dictated the evaluations were to include a more thorough evaluation of the patient's condition.

Review of the policy, Interoperative and Postoperative Anesthesia Evaluation and Documentation dated 6/12, indicated that a post anesthesia visit will be completed and documented, indicating the patient's condition and recovery from anesthesia. This follow-up evaluation was to include the patient's cardiopulmonary status and level of consciousness.