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Based on interview and documentation review it was determined the Hospital failed to ensure all patient medical record entries were legible and contained sufficient information to promote the continuity of care among providers.

Findings included:

The Medical Director of Infectious Disease was interviewed in person on 6/23/10 at 1:30 PM. He/She said He/She no long would perform consultation on any of Physician #4 or Physician #5's Patient because the suggestions he/she made for treatment were not acted upon. In addition both of these physician utilize a template to record progress notes and the level of the resulting documentation did not adequately address changes in a patient's status. He/She said if there was a change in a patients status Physician #4 and #5 made no effort to add the information to the template, check-list. Basically there was no integration of clinical relevant information.

Patient # 6's medical record was reviewed. Patient's 6's Attending Physician was Physician #4 and Physician #5 had also, on occasion, provided care to Patient #6.

Review of 6/12/10-6/26/10 integrated progress notes indicated template check off forms were utilized by both Physician #4 and #5 when assessing Patient #6. Progress notes written on June 12,13,14,15,16,17, 18,19 and 20 were authored by Physician # 4 . Sections of the written documentation was illegible. Integrated progress notes on June 21,22, 23 and 24, 2010 were written by Physician #5 and also contained sections of documentation that was illegible.

Based on interview and documentation review it was determined the Hospital failed to ensure the Corrective Action Plan related to the Hospital's internal Investigation of the care provided to one patient with hyponatremia was fully implemented.

Findings included:

Review of Hospital documentation indicated there had been a letter sent to the Hospital, dated 5/11/10 with concerns related to the care provided to Patient A. The specific issues identified in the letter related to the utilization of a BiPAP device and assessment of the Patient A ' s fluid status and correction of an electrolyte disturbance. The issues were reviewed at a medical staff committee meeting on 5/17/10 where it was agreed a pulmonologist would review Patient A ' s clinical care as it related to the reported concerns. The President of the Medical Staff, who was a pulmonologist, conducted the review on 6/8/2010. The review identified no issue with the utilization of a BiPAP device; however recommendations were made related to Physician #3 ' s treatment of the patient ' s hyponatremia. (Patient A was hyponatremic [the sodium concentration in the serum is lower than normal.] with a sodium on 131 on 5/3/10 and 129 on 5/4/10. Related to the hyponatremia Physician #3 wrote that hyponatremia persists despite increased free water and IV fluids. The water flushes per the PEG was increased from 150 to 200 milliliter every 8 hours.) The review identified the cause of the hyponatremia was due to congestive heart failure based on the clinical picture and the laboratory test values. The recommendation was for Physician #3 to receive some education related to the various causes of hyponatremia and supporting laboratory values which can help distinguish one diagnosis from the next. In addition the education should also include the treatment for hyponatremia that did not include providing a patient with more free water.

Hospital documentation indicated the formal report of the findings and recommendations were not reviewed until 6/30/10 during a medical staff committee meeting. The committee agreed with the recommendations related to Physician #3 receiving education and it was noted attending physician, Physician #3, was currently out on a leave of absence. The committee appointed a physician to speak with Physician #3 upon his/her return to work.

The June and July 2010 emergency medical services schedule and the June, 2010 calendar for attending physician coverage were reviewed. The documentation indicated Physician #3 was scheduled and continued to provide attending physician coverage on two occasion after the President of the Medical Staff's report was completed on 6/8/10.

The Chief Executive Officer (CEO) was interviewed in person on 7/13/10 at 3:50 PM. The CEO said and documentation indicated Physician B ' s last day worked was June 15, 2010.