HospitalInspections.org

Based on interview and record review the facility failed to follow their policy and procedure when Pitocin (Oxytocin - a medication that can help induce labor) was administered to a laboring patient (Patient 1) in the Emergency Department (ED).

This failure had the potential to put both mother and fetus at risk for harm.

Findings:

On August 5, 2024, an unannounced visit was conducted at the facility for an Emergency Medical Treatment and Labor Act (EMTALA) survey.

A review of Patient 1's electronic medical record (EMR), was conducted on August 5, 2024, at 11:50 a.m., with the Chief Nursing Officer (CNO). The facility document titled, "ED Provider Note," dated July 25, 2024, was reviewed. The document indicated, "...Chief Complaint...Uterine contractions G4 P4 [Gravida Para a medical term that relate to pregnancy and birth] first twin, LMP [Last Menstrual Period] Oct 2 [October] she said Aug 1st [August] according to pregnancy calculator wheel July 28; she starts contraction at about 5 p.m. now every 3 minutes, no prenatal [before birth] care, did not break her water no vaginal bleeding...Physical Exam...Bladder: non tender cervix 5cm [centimeters- unit of measurement] dilated occiput anterior station+1 [Positive numbers are used when a baby has descended beyond the pelvis] no free amniotic fluid [the clear or slightly yellow fluid that surrounds and protects an unborn baby as it grows during pregnancy]..."

A concurrent interview and record review was conducted on August 5, 2024, at 2: 27 p.m., with Physician 1, The facility document titled, "Progress Notes," dated July 25, 2024 was reviewed. The document indicated, "...Pitocin was started which advanced contraction...at 11:11 a.m..." Physician 1 stated Pitocin was started because Patient 1's delivery was not progressing. She also stated the ED is not equipped to continuously monitor the fetal heart tones during Pitocin infusion.

A concurrent interview and record review was conducted on August 6, 2024, at 8:15 a.m., with Physician 1. The facility's policy and procedure (P&P) titled, "ER Oxytocin (Pitocin) Administration" dated July 2022, was reviewed. The P & P indicated, "...Scope: Emergency Department...Use of Pitocin, oxytocin, Cervadil [medication that can help dilate the uterus], Cytotec [medication used to induce labor], or any other drug used to encourage labor in the emergency room for the purpose of delivering a live fetus is against the policy of [Name of Hospital]..." Physician 1 stated she was unaware of this policy.

A concurrent interview and record review was conducted on August 6, 2024, at 8:28 a.m., with the ED Manager. The facility's P&P titled, "ER Oxytocin (Pitocin) Administration" dated July 2022, was reviewed. ED manager stated she was unaware of the policy and further stated the policy was not followed when Pitocin was given to Patient 1 in the ED.

An interview was conducted on August 6, 2024, at 2:40 p.m., with Registered Nurse 3 (RN 3). RN 3 stated she was unaware of the policy indicating Pitocin cannot be given in ED and continuous fetal monitoring was not done during Pitocin infusion.