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Based on review of Pt #4's medical record,and review of the medical staff bylaws, rules and regulations, it was determined the medical staff (Physician #4) failed to complete a consultation request and evaluate Pt #4 within 24 hours as required by the bylaws.

Findings Include:

The hospital's bylaws and medical staff rules and regulations required: "...A satisfactory consultation includes examination of the patient as well as the health record. When operative procedures are involved, the consultation shall be recorded prior to the operation...Consultation must be rendered on a timely basis. Consultants are expected to see patient (sic) within 24 hours for situations that are not considered imminently serious or potentially life-threatening...."

Pt #4 was evaluated in the Emergency Department (ED) on 12/28/10.

There was an order for orthopedic consultation written on 12/28/09 at 1451, by the ED physician while the patient was still in the emergency room.

A review of the on-call physician for orthopedics for December 28, 2009, confirmed Physician #4 was on-call.

The patient was seen by Physician Assistant #7 for Physician #4 on 12/30/09 at 1453. The surgery was performed by Physician #4's partner, Physician #8 on 12/30/09 at 1604.

Physician #4, nor a partner, personally examined the patient within 24 hours, as required.

Based on review of medical records, policies and procedures and interview with patients and staff, it was determined a registered nurse failed to require a registered nurse evaluated the nursing services provided to Pt # 4, and other current inpatients, by failing to document every two hour repositioning per hospital policy.

Findings include:

The hospital's policy and procedure # 9273 "Moving and Positioning Patient in Bed, Realignment-Supine/Prone Position: Mosby Nursing Skills," and the policy titled Medical-Surgical Medical Practice Guidelines Policy #6496 required: "...Immobile patients will be repositioning every two (2) hours if physical condition allows...."

Employee #2, who cared for this patient in the ED, stated the patient asked numerous times to be re-positioned while there. The nurse remembers repositioning the patient with pillows and the assistance of an ED tech at least twice. This re-positioning was not documented. During the time the patient was in the ED (3 hours and 26 minutes), the patient had x-rays and CT scans performed. The patient was re-positioned during these procedures as well.

There is documentation that the patient was re-positioned while an inpatient, however, it is not documented every two hours.

According to a hospital audit of three additional medical records for current inpatients requiring every two hour repositioning, conducted by the hospital on 07/14/10 through 07/27/10, nursing failed to document repositioning every two hours per hospital policy.