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.
|PROVIDENCE ALASKA MEDICAL CENTER||3200 PROVIDENCE DRIVE ANCHORAGE, AK 99508||Aug. 14, 2019|
|VIOLATION: POSTING OF SIGNS||Tag No: A2402|
Based on observation and interview the facility failed to post signage specifying the rights of individuals under section 1867 of the Emergency Medical Treatment and Labor Act (EMTALA) with respect to examination and treatment of emergency medical conditions and women in labor, and that the facility participates in the Medicaid program under a State plan approved under Title XIX, in: 1) the entrance to the obstetrician (OB) triage; 2) the entrance from the ambulance bay into the main emergency department (ED) hall; 3) the waiting area of the pediatrics ED section of the main ED; and 4) the entrance into the Psychiatric (Psych) ED intake area from the car port area. This failed practice placed all patients entering the emergency department, and other areas that may be considered dedicated emergency departments, at risk for not being notified of their rights during an emergency medical condition or when in labor. Findings:
During observations on 8/13-14/19 revealed no signage that notified patients of the EMTALA patient rights: 1) upon entrance into the OB triage area; 2) upon entrance into main ED hall from the ambulance bay; 3) in the waiting area of the pediatric ED section and; 4) upon entrance directly into the Psych ED intake area from the car port entrance on the facility property.
During an interview on 8/14/19 at 11:37 am the Psych ED Manager stated there was no EMTALA signage posted in the intake area of the Psych ED. The Psych ED Manager further stated there was no EMTALA rights information within the Psych ED unit.
During an interview on 8/14/19 at 11:50 am, Pediatric Registered Nurse #1 stated there was no EMTALA rights signage posted within the pediatric ED section waiting area of the main ED.
During an interview on 8/14/19 at 12:06 pm, the Main ED Manager stated there was no EMTALA rights signage posted in the Main ED hall from the ambulance bay.
During an interview on 8/14/19 at 12:23 pm, the OB Charge Nurse stated there was no EMTALA rights signage posted at the OB Triage entrance or within the OB Triage area.
During an interview on 8/14/19 at 1:30 pm, the Regulatory Compliance Program Manager (RCPM) stated EMTALA signage should be posted in the OB and Psych ED.
Review of the facility's policy on 8/14/19, "Emergency Medical Treatment and Labor ACT (EMTALA)," last revised 8/2019, revealed no documentation for the EMTALA signage posting requirements or where the signs were to be posted.
Review of the facility's policy on 8/14/19, "Responsibilities to Provide Care, Medical Staff," last revised 6/2019, revealed no documentation for the EMTALA signage posting requirements or where the signs were to be posted.
|VIOLATION: EMERGENCY ROOM LOG||Tag No: A2405|
Based on record review and interview the facility failed to accurately track in a log, when encounters occur when patients are brought in via law enforcement, seeking psychiatric emergency care in the psychiatric emergency department (psych ED). This failed practice increased the risk of inaccurate accountability of patients seeking treatment, timely triage and treatment, and the disposition of the encounters. Findings:
Review of the emergency room log on 8/13-14/19 revealed no documentation of initial contacts with police officers when they come to the psych ED with a patient seeking emergency psychiatric treatment.
During an interview on 8/13/19 at 10:32 am, the Psych ED Manager stated if a police officer brings a patient to the psych ED for evaluation, but the initial triage could not occur right away (due to safety reasons, no beds available, or staff were conducting their start of shift report), the police officer would be asked to remain in his/her vehicle with the patient until such time as the initial triage could occur.
The Psych ED Manager further stated police officers may have to wait for up to an hour depending on the circumstances of the delay.
During an interview on 8/14/19 at 11:37 am, the Psych ED Manager stated there was no documentation, or log, to indicate when a police officer arrives with a patient seeking emergency psychiatric care until such time as when the initial triage is started by a nurse. The Psych ED Manager further stated there is no contact, or triage, that occurs with these patients until such time as when the initial triage begins.
During an interview on 8/14/19 at 1:30 pm, the Regulatory Compliance Program Manager (RCPM) stated she was not aware the police officers were having to wait in their cars with patients being brought to the Psych ED. The RCPM stated the Psych ED should be keeping a log of any patient on the hospital property who presents to be seen.
Review of the facility's policy "Psychiatric Emergency Department Standard Practice Guideline for Nurses," which was provided by the facility on 8/13/19 but not yet approved for implementation ("effective: Upon Approval"), revealed: "Arrival From Law Enforcement or Fire Department ...When they are on our property: obtain the patient's name, date of birth, reason for admission, cooperative status, and verify the officer is signing a NED [notice of emergency detention] ..."
Review of the facility's policy "Care of the Patient in the Psychiatric Emergency Department, Behavior Health," last revised 1/2018, revealed: " ...patients transported to the Psych ED by APD will be immediately triaged by the psychiatric ED RN and those requiring urgent medical attention are transferred to the main ED ..."