HospitalInspections.org

Based on a review of facility documents, medical records (MR) and staff interview (EMP), it was determined the facility failed to ensure that their adopted Anesthesia Consent form was completed with required documentation on three out of four pediatric medical records reviewed (MR15, MR16 and MR21).

Findings include:

Review on December 14, 2106 of facility policy, Delivery of Anesthesia Care, last reviewed November 22, 2016, revealed, "Anesthesia Consent Forms: The Anesthesia Consent Form documents the fact that the Anesthesiologist discussed the anesthesia plan with the patient and a choice regarding anesthesia was agreed upon by patient and Anesthesiologist. This Consent documents discussion including risks, benefits, alternatives, and potential complications occurred with the patient or designated alternate decision maker. The Consent Form is a documentation of the patient's consent. ... ."

Review on December 14, 2106 of facility form, Informed Consent to Anesthesia, last reviewed May 2105, revealed designated space for documentation of the following: " The patient is unable to sign the consent because of: ( ) age, ( ) confused, ( ) unresponsive-or ... Relationship to Patient"

Review on December 14, 2016 of facility form, Informed Consent To Surgery/Procedure/Therapy, no review date, revealed designated space for documentation of the following: "Relationship to Patient"

Review of MR15 on December 14, 2016, revealed an Informed Consent To Anesthesia form dated December 29, 2015. Further review revealed no documentation indicating the relationship of the person signing the consent for MR15 or the reason why the patient was unable to sign.

Interview with EMP1 and EMP2 on December 14, 2016, at 11:50 AM, confirmed an Informed Consent To Anesthesia form dated December 29, 2015 for MR15. Further interview confirmed no documentation indicating the relationship of the person signing the consent for MR15 or the reason why the patient was unable to sign.

Review of MR16 on December 14, 2016, revealed an Informed Consent To Anesthesia form dated December 29, 2015. Further review revealed no documentation indicating the relationship of the person signing the consent for MR16 or the reason why the patient was unable to sign.

Interview with EMP1 and EMP2 on December 14, 2016, at 11:50 AM, confirmed an Informed Consent To Anesthesia form dated December 29, 2015 for MR16. Further interview confirmed no documentation indicating the relationship of the person signing the consent for MR16 or the reason why the patient was unable to sign.

Review of MR21 on December 14, 2016, revealed an Informed Consent To Anesthesia form dated June 30, 2016. Further review revealed no documentation indicating the relationship of the person signing the consent.

Interview with EMP1 and EMP2 on December 14, 2016, at 11:50 AM, confirmed an Informed Consent To Anesthesia form dated June 30, 2016 for MR15. Further interview confirmed no documentation indicating the relationship of the person signing the consent.

Review of MR20 on December 14 2016, revealed an Informed Consent To Surgery/Procedure/Therapy form dated June 2, 2016. Further review revealed no documentation indicating the relationship of the patient signing the consent.

Interview with EMP1 and EMP2 on December 14, 2016, at 11:50 AM, confirmed an Informed Consent To Surgery/Procedure/Therapy form dated June 2, 2016. Further interview revealed no documentation indicating the relationship of the patient signing the consent.