HospitalInspections.org

Based on review of facility documents and staff interview (EMP), it was determined the facility failed to ensure the assignments of personnel were made in a manner to minimize the risk of cross infection for the inpatients on the Obstetrical Unit and failed to ensure the inpatient Obstetrical Unit was protected from unrelated traffic through the suite by permitting Same Day Surgery patients to be admitted and discharged from the Obstetrical Unit following their outpatient surgery for 21 of 21 medical records reviewed (MR1, MR2, MR3, MR4, MR5, MR6, MR7, MR8, MR9, MR10, MR11, MR12, MR13, MR14, MR15, MR16, MR17, MR18, MR19, MR20, and MR21).

Findings include:

1) Review on February 25, 2016 of the facility policy "Patient Care Assignment," dated April 13, 2004, revealed "Purpose The philosophy of the Patient Service Department is that each patient who enters the hospital should have adequate care provided by competent personnel. Scope/Guidelines Charge Nurse 1. Assigns patient care by: a. Assessing patient care needs including their level of care, the complexity of the nursing care required, and any age specific care needs they may have. b. Assessing the individual employee's capabilities and competencies in caring for the patient assignment as defined in their job description. c. Reassessing the patient assignment as patient condition changes requiring increased skill level or staff support. d. Planning assignments in a manner, which minimizes the risk of cross infection. ..."

Review of the staffing schedules for February of 2016 revealed staff assignments to certain areas of the Obstetrical Department to include the newborn nursery, labor and delivery and post partum. There was no documentation of patient individual assignments to ensure the patient care assignments were made to minimize the risk of cross infection.

Interview on February 25, 2016, with EMP3, EMP4, EMP5, EMP6 and EMP7 confirmed there were times they were assigned to a Same Day Surgery patient (an outpatient) and inpatient post partum mothers. Specifics dates were not provided. EMP3, EMP4, EMP5, EMP6 and EMP7 confirmed this in individual interviews.

Interview with EMP8 on February 25, 2016, at 11:30 AM confirmed there was no documentation of the individual nursing assignments to ensure assignments were made to limit the possibility of cross infection.

2) Review of the facility's "Department of Obstetrics Scope of Patient Care Services," dated May 11, 2015, revealed "I. Scope of Service a. Types of Patients Served: Pocono Medical Center Obstetrical Unit provides care to women of child bearing age and their newly born infants. b. Major Conditions/Most Frequent Diagnoses Treated: The obstetrical unit provides treatment for pregnancy and the complications associated with this condition. The obstetrical unit also provides care for the newly born healthy neonate. ... Policy It is the policy of Pocono Medical Center to admit non obstetric patients to our maternity unit under specific circumstances. The criteria to be used is as follows: 1. Sufficient OB [obstetric] beds must be available to allow for any sudden influx of obstetrical patients. 2. At no time will obstetrical patients be denied a bed because of the presence of a non obstetric patient. 3. Non-OB-GYN [obstetrical-gynecological] patients should only be admitted when there are no Med-Surg [medical-surgical] beds available. 4. Only female patients will be included. 5. The following categories of non obstetric patients meet criteria: A. Clean gynecological surgery B. Breast Surgery, excluding mastectomy C. GU [genitourinary] surgery such as: bladder suspension, stamey perera suspension, other ureteral surgery D. ACTH adrenocorticotrophic hormone] therapy - usually on multiple sclerosis patients E. Laparoscopic cholecystectomies. ..."

An observation tour of the Obstetrical Unit on February 25, 2016, revealed the unit included rooms 200 through 211. All outside traffic into the Obstetrical Unit must pass the entrance to the Nursery and Neonatal Intensive Care Unit. The Obstetrical Unit had a secured locked entrance, and visitors must request the door to be unlocked to be admitted to the Obstetrical Unit.

Review on February 25, 2016, of the operating room schedules from June 2015 to present revealed the following cases were admitted to the Same Day Surgery Unit for outpatient surgeries. These outpatient were then sent to the Obstetrical Unit post operatively and discharged home from the Obstetrical Unit:

Review of MR1 revealed a surgery date of February 9, 2016, for a dilatation and curettage. The nurses' notes revealed at 1135 the patient was received to room 207W from the Post Anesthesia Care Unit (PACU). The patient was discharged at 1249 from the Obstetrical (OB) Unit.

Review of MR2 revealed a surgery date of February 23, 2016, for a bilateral salpingectomy. The patient was admitted to the OB Unit at 1320 and discharged at 1640. The patient room number was not listed. The patient was taken care of by EMP1 who was assigned to work on the OB Unit on that date and time.

Review of MR3 revealed a surgery date of February 23, 2016, for a LEEP procedure (loop electrosurgical excision procedure). The patient was transferred from PACU to room 204D at 1220. The patient was discharged from the OB Unit at 1345.

Review of MR4 revealed a surgery date of December 9, 2015, for a hysteroscopy. The nurses' notes revealed the patient was transferred from PACU to 205D at 1055 with a discharge time of 1200.

Review of MR5 revealed a surgery date of December 9, 2015, for a hysteroscopy. The nurses' note revealed the patient was received into room 205W from PACU at 955 and discharged from the OB Unit at 1119.

Review of MR6 revealed a surgery date of October 26, 2015, for a diagnostic laparoscopy and bilateral salpingectomy. The patient was transferred from PACU to Room 205 at 1650 with a discharge time of 1845 from the OB Unit.

Review of MR7 revealed a surgery date of December 30, 2015, for a LEEP procedure. The patient was transferred from PACU to Room 211D at 1540 with a discharge time of 1751 from the OB Unit.

Review of MR8 revealed a surgery date of December 30, 2015, for a laparoscopic right ovarian cystectomy. The patient was transferred from PACU to 211W at 1225 with a discharge time of 1444 from the OB Unit.

Review of MR9 revealed a surgery date of February 19, 2016, for a hysteroscopy. The nurses' note revealed the patient was received in OB from PACU at 1400 with a discharge time of 1510 from the OB Unit. The patient room number was not listed. The patient was taken care of by EMP9 who was assigned to work on the OB Unit on that date and time.

Review of MR10 revealed a surgery date of February 19, 2016, for a hysteroscopy. The nurses' note revealed the patient was received into room 200 from PACU at 1050 and discharged from the OB Unit at 1335.

Review of MR11 revealed a surgery date of February 19, 2016, for a hysteroscopy, dilatation, and curettage. The nurses' note revealed the patient was admitted to the OB unit from PACU at 1326 and discharged from the OB Unit at 1550. A patient room number was not listed. The patient was taken care of by EMP4 who was assigned to work on the OB Unit on that date and time.

Review of MR12 revealed a surgery date of November 6, 2015, for a hysteroscopy. The nurses' note revealed the patient was received into room 204 from PACU at 1045 and discharged from the OB Unit at 1322.

Review of MR13 revealed a surgery date of June 30, 2015, for a hysteroscopy, dilatation, and curettage. The nurses' note revealed the patient was received in room 207D at 1710 and discharged from the OB Unit at 1805.

Review of MR14 revealed a surgery date of June 30, 2015, for a hysteroscopy. The nurses' note revealed the patient was received in the OB Unit at 1650 and discharged from the OB Unit at 1927. A patient room number was not listed. The patient was taken care of by EMP10 who was assigned to work on the OB Unit on that date and time.

Review of MR15 revealed a surgery date of July 24, 2015, for a hysteroscopy. The nurses' note revealed the patient was received into room 206 from PACU at 1715 and discharged from the OB Unit at 1730.

Review of MR16 revealed a surgery date of December 30, 2015, for a hysteroscopy. The nurses' note revealed the patient received into room 210W from PACU at 0955 and discharged from the OB Unit at 1040.

Review of MR17 revealed a surgery date of February 22, 2016, for a dilatation, curettage, and hysteroscopy. The nurses' note revealed the patient was received into room 207W from PACU at 1555 and discharged from the OB Unit at 1710.

Review of MR18 revealed a surgery date of February 22, 2016, for a hysteroscopy. The nurses' note revealed the patient was admitted to the OB Unit at 1742 and discharged at 1900. A patient room number was not listed. The patient was taken care of by EMP4 who was assigned to work on the OB Unit on that date and time.

Review of MR19 revealed a surgery date of December 15, 2015, for a bilateral tubal ligation. The nurses' note revealed the patient was admitted to the OB Unit at 1140 and discharged at 1300. A patient room number was not listed. The patient was taken care of by EMP13 who was assigned to work on the OB Unit on that date and time.

Review of MR20 revealed a surgery date of December 15, 2015, for a LEEP procedure and cone biopsy. The nurses' note revealed the patient was admitted to the OB Unit at 1520 and discharged at 1620. A patient room number was not listed. The patient was taken care of by EMP7 who was assigned to work on the OB Unit on that date and time.

Review of MR21 revealed a surgery date of July 23, 2015, for a dilatation, curettage, and hysteroscopy. The nurses' notes revealed the patient was admitted to the OB Unit at 1315 and discharged at 1845. A patient room number was not listed. The patient was taken care of by EMP7 who was assigned to work on the OB Unit on that date and time.

Interview with EMP2 on February 25, 2016 at 1300 confirmed the Same Day Surgery patients (outpatients) were sent to the inpatient Obstetrical Unit postoperatively and discharged the same day. EMP2 confirmed the practice of providing care for outpatients in the licensed inpatient unit was in place for an extended period of time.