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NORTH METRO MEDICAL CENTER 1400 BRADEN STREET JACKSONVILLE, AR 72076 July 23, 2019
VIOLATION: EMERGENCY ROOM LOG Tag No: A2405
Based on review of the emergency room (ER) Log, review of the Medical Staff Rules and Regulations, policy and procedure review, and interview, it was determined the facility failed to accurately and completely record Patient #25's ER presentation into the ER Log. Failure to enter Patient #25's name into the ER Log did not allow the facility to track Patient #25's presentation and treatment. The failed practice affected Patient #25 and had the likelihood to affect all patients presenting to the ER. Findings included:

A. Review of Medical Staff Rules and Regulations under "General Rules Regarding Emergency Services," on 07/23/19, showed, "an appropriate medical record shall be kept for every patient receiving emergency service and be incorporated into the patient's hospital record, if such exists. The record shall include: Adequate patient identification; Information concerning the time of the patient's arrival, means of arrival and by who transported ...".

B. Review of the facility's policy titled, "Admission of Patient to Emergency Department, EMTALA Regulations," on 07/23/19, showed all patients must be logged in and a permanent record produced.

C. The findings of A and B were confirmed in an interview with the Chief Executive Officer (CEO) on 07/23/19 at 12:40 PM.

D. Review of the ER Log for June and July 2019 on 07/23/19 showed there was no evidence Patient #25 was placed on the ER Log. The findings were confirmed in an interview with Registered Nurse (RN) #1 on 07/23/19 at 11:50 AM.

E. On 07/23/19 at 10:30 AM Licensed Practical Nurse (LPN) #1 was interviewed. LPN #1 stated Patient #25 presented to the ER via Emergency Medical Services (EMS). LPN #1 stated Physician #1 told EMS the patient needed to go elsewhere. LPN #1 stated EMS brought her in the door, placed her in a room, then went right back out on the stretcher. LPN #1 stated Patient #25 presented with chief complaint that she thought she was miscarrying. LPN #1 stated she did not remember the patient's name.

F. On 07/23/19 at 10:35 AM, RN #2, who was working in he ER on 07/23/19, was interiewed. RN #2 stated he had no recolection of this incident.

G. On 07/23/19 at 11:50 AM, RN #1 was interviewed via telephone. RN #1 stated Patient #25 arrived at the ER about one week ago through EMS. RN #1 stated the ER alerted the EMS crew that North Metro Medical Center was an inappropriate facility due to not having OB (obstetrics) services. RN #1 stated EMS still brought Patient #25 in due to the patient's transportation home. RN #1 stated Patient #25 was in the ER approximately one and a half minutes with profuse bleeding. RN #1 stated Patient #25 was transferred from the hospital bed to the EMS gurney with profuse bleeding noted on both beds. RN #1 stated that EMS crew said, "We need to move with her." RN #1 stated Patient #25 signed an AMA (Against Medical Advice) form. RN #1 stated Patient #25's name was withheld from them so they could not register the patient. RN #1 stated the AMA form was in his mailbox in the ER. RN #2 stated he didn't know what to with it (AMA form). RN #1 stated Patient #25 made the decision to go to another facility. RN #1 stated Patient #25 was not placed on the ER Log because no name was given.

H. On 07/23/19 at 12:20 PM Physican #1 was interviewed via telephone. Physician #1 stated, to his understanding, Patient #25 signed an AMA form. Physician #1 stated he did not touch the patient. Physician #1 stated he had heard about the blood on the gurney and bed but he did not see it himself. Physician #1 stated to his understanding she immediately stated she didn't want to stay. Physician #1 stated he did not assess Patient #25. Phsycian #1 stated Patient #25 signed an AMA form and he felt he couldn't legally touch the patient.

I. The CEO retrieved the AMA form from RN #1's mail box in the ER on 07/23/19. The AMA form was signed on 07/17/19 at 11:05 AM.