HospitalInspections.org

Based on medical record review, credentialing review, and interview, the facility failed to ensure a physician followed accepted standards of practice, necessitating additional medical care for one (#4) of five patients reviewed.

The findings included:

Medical record review revealed patient #4 presented to the Emergency Department on July 11, 2011, at 3:02 p.m., with complaint of having been bitten on the face by a dog.

Review of nursing assessment dated July 11, 2011, revealed "...Laceration under left eye. No bleeding at this time. No visual difficulty or redness to eye itself. Small amount of swelling noted to left side of face with bruising...".

Review of the physician's assessment dated July 11, 2011, revealed the patient had a "...1 centimeter laceration on face below left eye...". Continued review of the physician's assessment dated July 11, 2011, revealed notes from the physician "...When I tried to use Dermabond (glue-type application to approximate wound edges) apply to wound it accidentally contacted eye lid and eye lash. Patient was not able to open eye but had no pain. We tried to use mineral oil, vaseline, and warm compresses on left eye. Only partially resolved the aggregation of eye lash or eyelid. Child is able to open eye but not wide. Immediate consult with Ophthalmologist...".

Review of the notes from the ophthalmologist dated July 11, 2011, revealed the patient still had dermabond on the eyelid; was able to open the eye but not fully; and refused a visual acuity examination. Continued review of ophthalmology notes dated July 15, 2011, revealed there was still one spot of Dermabond remaining on the eyelid and visual acuity was intact.

Interview with the Quality Director (QD) and Chief Nursing Officer (CNO) on May 30, 2012, at 9:40 a.m., in the Administrative Board Room, revealed the physician was no longer employed by the facility. Continued interview revealed the physician was very upset about the incident when interviewed by the Risk Manager. Further interview with the QD revealed "...some of the Dermabond was inadvertently placed on the lower eyelid; the patient blinked; and the lids were glued together...".

Review of the physician's credentialing file revealed the physician had privileges to care for patients with eye injuries and lacerations approved by the Medical Executive Committee and the Governing Board.