HospitalInspections.org

Based on medical review, document review, and interview, in 4 of 28 medical records reviewed, the facility failed to implement its Emergency Department policies and procedures to ensure that obstetric patient's fetal monitoring strips are reviewed by a physician prior to discharge (Patient #s 1, 2, 3 and 5).

This failure may have placed patients at risk for potential harm.

Findings include:

See Tag A-1104.

Based on medical record review, document review and staff interview, the facility failed to implement its Emergency Department policy and procedures to ensure that obstetric patient's fetal monitoring strips are reviewed by a physician prior to discharge.

These findings were noted in in 4 of 28 records reviewed (Patient #s 1, 2, 3 and 5).


This failure may result in patient harm.

Findings include:

1. Review of the medical record for Patient #1 identified a 23-year-old female at 38.50 weeks of gestational age who presented to Labor and Delivery triage on 07/16/17, at 04:39 PM with complaints of contractions every 2-4 minutes apart and a pain intensity of 5 on a pain scale of 1 to 10.

Staff A, Registered Nurse (RN) assessed the patient and performed Fetal Heart Monitoring. At 05:00 PM, nurse noted that she reported her findings to the physician.

At 06:49, nurse documented that patient's contractions are irregular and milder; and that patient's physician was notified of the patient's status. "Decision was made to discharge the patient home ...."

Review of the facility's policy titled "Evaluation of Labor," approved 06/17, notes that " .... Obstetricians may defer care to the Laborist (An obstetrician-gynecologist who works full-time in a hospital or for a physician group exclusively to treat women in labor);" and that a physician "must review the fetal monitoring strip and fetal monitoring assessment prior to discharging the patient. Name of MD reviewing the tracing must be documented in the Electronic Medical Record (EMR). Patients are discharged by MD order only."

There was no indication that the fetal monitoring strip and fetal monitoring assessment conducted by the nurse were reviewed by a physician prior to the patient's discharge.

On 09/14/2017, at 03:35 PM, during an interview with Staff A, Registered Nurse, she reported that she communicated her evaluation of the patient and the fetal heart monitoring assessment to the physician. The physician told her to discharge the patient, but she denied that the physician instructed her to re-examine the patient before her discharge.

On 09/18/2017, at 01:15 PM, during the interview with Staff I, Obstetrician/Gynecologist (OB/GYN), he stated that he instructed the nurse to call a hospitalist for an evaluation of the patient prior to discharge.

During interview with Patient #1 on 09/26/2017 at 01:30 PM, she stated that she was not evaluated by a physician during her visit, and that the nurse was the only person she saw and spoke to. The patient stated that the nurse told her that she is not in labor and will be discharged home. She reported that she was discharged on 9/26/17 at approximately 7:00 PM. During the discharge, she complained to the nurse that she was still in pain. The patient stated that she delivered her baby in the bathroom of her residence at 9:18 PM, two hours after discharge.

Similar findings were noted for patients #2, #3 and #5. There was no documentation that the fetal monitoring strip and fetal monitoring assessment conducted by the nurse were reviewed by a physician prior to the patient's discharge."


On 09/18/2017, at 12:00 PM, these findings were discussed with Staff C, Assistant Director of Quality and, on 09/19/2017, at 10:30 AM with Staff F, Director of Quality, who acknowledged findings.