The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

BAPTIST MEDICAL CENTER 111 DALLAS STREET SAN ANTONIO, TX 78205 Sept. 25, 2012
VIOLATION: NURSING CARE PLAN Tag No: A0396
1. Based on reviews of medical records, policies and procedures, and staff interviews Baptist Medical Center Outpatient Endoscopy Lab failed to conduct a nursing assessment and develop a nursing care plan.
The findings included:
a. A review of the medical record conducted with staff members # 1 and # 2 on 9/25/12 at 10:00 in the hospital's conference room revealed the nursing staff failed to conduct a nursing assessment and develop a care plan to prevent the patient from falling out of bed. Available information from the patient's primary care physician including her diagnosis of "advanced dementia" and family members who accompanied the patient and capable of providing historical medical and injury information were not utilized until after the patient was injured.
b. A review of the hospitals' Fall Prevention" policies and procedures conducted on 9/25/12 at in the conference and again in the Endoscopy Lab revealed the nursing staff failed to perform basic fall prevention measures and there was no evidence the nursing staff conducted a nursing assessment prior to the planned outpatient procedure Esophagoscopy Gastroscopy Duodenoscopy (EGD) or updated nursing plan of care that incorporated the patient's history of recent falls.
c. Staff interviews conducted with staff members # 3 and # 4 conducted on 9/25/12 at 11:45 a.m. in the Endoscopy Lab revealed they witnessed the patient fall onto the floor that resulted in the patient suffering fractures to the face and wrist as well as sutures to repair a laceration to the face. Both staff members also acknowledged the fall could have been prevented if the bed rails had been up and in the locked position. After their own review of the findings staff members #1 and #2 agreed the nursing staff failed to properly assess the patient and to develop and implement a nursing plan of care to meet the patient's needs.
VIOLATION: INTEGRATION OF OUTPATIENT SERVICES Tag No: A1077
1. Based on medical record reviews, reports, policies and procedures, and staff interviews Baptist Medical Center failed to integrate acceptable nursing standards of practice and patient safety measures in the outpatient departments offered by the hospital.
The findings included:
a. Review of the patient's medical record conducted on 9/24/12 and again on 9/25/12 with staff member # 1 in the hospital's conference room revealed the Endoscopy Lab nursing staff failed to conduct a comprehensive nursing assessment prior to performing an outpatient procedure capable
of identifying the patient at a high risk for falls. Further reviews revealed there was also no evidence the staff utilized tools established by the hospital to develop and implement a nursing care plan to meet the patient's immediate and post procedure needs.
b. A review of the hospitals policies and procedures and training reports conducted on 9/25/12 in the conference room with staff member # 1 revealed the nursing staff of the endoscopy lab were recently trained in assessing and implementing high risk fall preventive measures. Staff member # 1 acknowledged the hospital was actively expanding these standard measures for inpatient services to the outpatient departments and were approximately 90% complete.
c. Interviews with staff members # 3 and # 4 conducted on 9/25/12 at 11:50 a.m. revealed they both failed to implement basic fall prevention measures, did not utilized established protocols to identify patients at an advanced risk for falls or post fall procedures.