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Based on clinical record review, policy review, observation, and interview, the facility failed to ensure one (#1) of one patient received an appropriate medical screening exam (MSE) before Patient # 2 was discharged, in active labor, to ensure or minimize the discharge risk to Patient # 2 and health of the unborn child. The failed practice affected Patient #1 and had the likelihood to affect all patients presenting to the Emergency Department (ED). Findings follow:

A. Review of the Policy and Procedure titled "OB Medical Screening Exam Process" revised date of 05/01/2020, showed the following:
1. The policy purpose was to ensure appropriate medical screening and timely medical intervention for patients seeking care for emergent obstetrical conditions.
2. The function of the MSE showed the following were to be included:
a. The assessments of obstetric history and information and review of prenatal record,
b. A vaginal exam would be completed to determine the state of the cervix, presenting part, state of membranes and bleeding.
c. Determine nutritional/hydration status.
3. If maternal and fetal are stable and true labor and/or medical emergency can be excluded, the physician may elect to discharge the patient.
4. Documentation of the medical screening exam, patient log for Labor and Delivery Activity and Disposition log was to be completed.
5. Obstetric patients from 20 weeks gestation, presenting with obstetrical emergency, was to be assessed and documentation of MSE recorded in their record.

B. Review of the Policy and Procedure titled "Management of Patient Experiencing Variations of Fetal Heart Rate (FHR) Patterns" revised 05/17/2022, showed to notify physician of change in FHR pattern and nursing interventions performed.

C. Review of the Policy and Procedure titled "Patient Care Services", revised 05/01/2022 showed the following:
1. Assessments included to monitor FHR with external EFM (Electronic Fetal Monitor) and chart baseline and contraction pattern.
2. Observe for signs of complications or changes in condition and notify physician immediately for any variation in FHR.

D. Review of (Named EMS) flowsheet dated 04/04/2024, showed the patient was transported to South Arkansas Regional Hospital with complaints of frequent contractions. The patient was discharged home.

E. On 04/05/2024 at 00:26 AM, the same (Named EMS) crew transported the patient to South Arkansas Regional Hospital post home delivery of newborn.

F. Review of OB (Obstetric) Triage dated 04/04/2024, showed the following:
1. The patient had a history of gestational hypertension and anxiety.
2. At 6:52 PM, the patient complained of having contractions and a headache 9/10 on the pain scale and had taken Hydrocodone.
3. At 7:08 PM, the pain was 9/10 on the pain scale with intermittent contraction in the back and abdomen.
4. At 7:29 PM, the (Named Physician) was contacted and no order was given for discharge.
5. At 8:00 PM, the fetal monitoring showed the uterine activity contraction pattern with a frequency every 1-15 minutes lasting 60-80 seconds and fetal assessment with moderate variability and early variable decelerations with average Fetal Heart Rate 140.
6. At 8:34 PM, the patient was given discharge instructions and at 8:52 PM discharged home.

G. Review of OB (Obstetric) Triage dated 04/05/2024, showed at 00:37 AM, the patient was admitted to the Labor and Delivery (LD) unit post home delivery.

H. Review of Order history dated 04/04/2024, showed the following orders:
1. At 6:57 PM, a one-time phone order to perform a sterile vaginal exam and electronic fetal monitoring.
2. At 7:33 PM, a phone order to discharge home.

I. Review of LD flowsheet dated 04/04/2024, showed the following:
1. At 8:32 PM, the IV was removed from her right hand.
2. There was no evidence the patient had her cervix checked for dilation and/or effacement.

J. During the interview on 04/11/2024 at 11:30 AM, the Chief Nursing Officer confirmed the findings in A-I.