HospitalInspections.org

This Condition is found to be out of compliance due to a Life Safety Survey.

Based on review of facility documents, medical records and interview with facility staff (EMP), it was determined the facility failed to ensure services provided to inpatients were provided in a healthcare approved building.

Findings include:

Review on April 5, 2012, of the facility's policy "Dialysis Protocol," last revised April 2007, revealed "Procedure: Obtain a physician's order for dialysis and necessity to transport patient to dialysis unit stating location and frequency of treatments."

Review of MR 46 revealed an admission of February 27, 2012, and discharge of March 3, 2012, secondary to mental changes and return to an acute care facility. The patient was readmitted on March 6, 2012, and discharged on March 22, 2012. During the inpatient admissions the patient was transported via wheelchair van to another facility for renal dialysis on February 29, 2012, March 2, 7, 9, 12, 14, 16, 19 and 21, 2012.

Telephone interview with EMP2 on April 5, 2012, confirmed the dialysis treatment was provided in a non healthcare approved building.


Cross reference:
482.22(c) Medical Staff Bylaws
482.24(c)(2)(vi) Content of Record - Other Information

Based on review of the facility's Medical Staff Rules and Regulations, medical records (MR) and interviews with facility staff (EMP), it was determined the facility failed to ensure transfers to another level of care, health professional or setting were based upon the patient's assessed needs and the facility's capacity to provide care as defined in their Rules and Regulations for nine of nine medical records where transfers occurred (MR11, MR12, MR13, MR14, MR15, MR16, MR17, MR18 and MR19)

Findings include:

Review of the facility's "Allied Services Rehabilitation Hospital Medical Staff Rules and Regulations," dated Board Approved November 2011, revealed "... 3. Transfer of Care A. Transfer to Another Service Whenever the care of the patient is transferred to another service, a note covering the transfer of responsibility shall be entered in the medical record. B. Transfer to Another Level of Care Transfers of care or discharge of patients to another level of care, health professional or setting are based upon the patient's assessed needs and the Institute's capacity to provide the care. Transfers are conducted in accordance with the Institute's policies and procedures."

Review of MR11 revealed an admission date of December 16, 2011, and discharge of January 20, 2012. During this inpatient stay, the patient was transferred to a physician's office on January 4, 2012, for a cardiology follow up and again on January 5, 2012, to the cardiothoracic surgeon. There was no documentation within the record that the patient was assessed for the necessity of these visits. Further documentation revealed the visit on January 4, 2012, was to a physician who was currently credentialed at Allied Services Institute of Rehabilitation.

Review of MR12 revealed an admission date of December 20, 2011, and discharge January 9, 2012. During this inpatient stay, the patient was transferred to a physician's office on January 3, 2012, for an orthopedic surgical follow up for cast removal and on January 5, 2012, for orthopedic follow up. There was no documentation within the record that the patient was assessed for the necessity of these visits. Further documentation revealed the visits on January 3 and 5, 2012, were to see physicians currently credentialed at Allied Services Institute of Rehabilitation.

Review of MR13 revealed an admission date of January 18, 2012, and discharge of January 30, 2012. During this inpatient stay, the patient was transferred to a physician's office on January 23 and 30, 2012, for follow up for their podiatric surgery. There was no documentation within the record that the patient was assessed for the necessity of these visits.

Review of MR14 revealed an admission of January 27, 2012, and discharge of February 24, 2012. During this inpatient stay, the patient was sent to physician's office for wound care follow up on February 15 and 22, 2012, and for an infectious disease follow up on February 9, 2012. There was no documentation within the record that the patient was assessed for the necessity of these visits. Further documentation revealed these visits on February 9, 15 and 22, 2012, were to physicians currently credentialed at Allied Services Institute of Rehabilitation. Further review revealed the wound care physician had given wound care orders on February 2, 2012, and the facility was providing the redressing.

Review of MR15 revealed an admission date of January 5, 2012, and discharge of February 1, 2012. During this inpatient stay, the patient was sent to a physician's office on January 26, 2012, for a cardiology follow up and on January 30, 2012, for a neurology follow up. There was no documentation within the record that the patient was assessed for the necessity of these visits.

Review of MR16 revealed an admission date of February 14, 2012, and discharge of March 11, 2012. During this inpatient stay, the patient was sent to a physician's office on February 22, 2012, and March 1, 2012, for follow up visits with trauma. There was no documentation within the record that the patient was assessed for the necessity of these visits.

Review of MR17 revealed an admission date of January 25, 2012, and discharge of March 3, 2012. During this inpatient stay, the patient was sent to a physician's office on February 6, 2012, and March 1, 2012, for follow up podiatry visits after foot surgery There was no documentation within the record that the patient was assessed for the necessity of these visits.
Further documentation revealed the visits on February 6, 2012, and March 1, 2012, were to a physician currently credentialed at Allied Services Institute of Rehabilitation.

Review of MR18 revealed an admission of February 25, 2012, and discharge of March 13, 2012. During this inpatient stay, the patient was sent to a physician's office for orthopedic follow up on February 28, 2012, and March 13, 2012. There was no documentation within the record that the patient was assessed for the necessity of these visits.

Review of MR19 revealed an admission of January 3, 2012, and discharge of January 18, 2012. During this inpatient stay, the patient was sent to another facility for wound care on January 9, 12, and 20, 2012. There was no documentation within the record that the patient was assessed for the necessity of these visits. Further review revealed these wound care visits on January 9, 12, and 20, 2012 were to a physician currently credentialed at Allied Services Institute of Rehabilitation.

Interview with OTH1 on March 29, 2012, at approximately 1:30 PM confirmed these follow up visits were scheduled prior to these patients' admission to Allied Services Institute of Rehabilitation. OTH1 further confirmed there was no documentation within MR11, MR12, MR13, MR14, MR15, MR16, MR17, MR18, and MR19 that the necessity of these transfers were assessed by the physician.

Based on review of facility documents, medical records (MR), and interview with facility staff (EMP), it was determined the nursing staff failed to ensure orders for treatment were carried out only when given by a qualified physician, dentist, podiatrist, optometrist, or other person duly licensed or authorized by the State of Pennsylvania, and who had approved clinical privileges at the hospital for three of nine medical records reviewed involving transfers (MR11, MR 17 and MR18).

Findings include:

Review of the facility's "Rehabilitation Hospital Medical Staff Rules and Regulations," revealed "... 8. Physician Orders A. General Requirements Orders for patient treatment and medications, including the administration of medications, will be carried out only when given by a qualified physician, dentist, podiatrist, optometrist, or other person duly licensed or authorized by the State of Pennsylvania, and who have approved clinical privileges at the hospital."

Review of MR11 revealed the following order written on December 9, 2011, "if no drainage from CABG [coronary artery bypass graft] incision, OK to dc [discontinue] Betadine dressing and leave open to air." This physician order was obtained as a telephone order from OTH2. OTH2 was not credentialed at the Allied Services Institute of Rehabilitation.

Review of MR17 revealed the following order written on February 20, 2012, "soap and water BID [twice a day] wound DC xeroform". This physician order was obtained as a telephone order from OTH3. OTH 3 was not credentialed at Allied Services Institute of Rehabilitation.

Review of MR18 revealed the following order written on March 7, 2012, "elevate legs, OK to remove ace wrap per Dr [OTH3]." OTH 3 was not credentialed at Allied Services Institute of Rehabilitation.

Interview with EMP1 on March 29, 2012, at approximately 11:00 AM confirmed the nursing staff were to check to see if the physicians were credentialed at the hospital prior to accepting a telephone order. EMP1 further confirmed each nursing unit had a listing of the credentialed physicians.

Based on review of facility documents, medical records (MR), and interview with facility staff (EMP), it was determined the facility failed to ensure the results of consultative evaluations and appropriate findings by clinicians were included within the medical record for one of nine records where the patient was transferred to another facility for care (MR15).

Findings include:

Review of the facility's "Rehabilitation Hospital Medical Staff Rules and Regulations," dated revised November 2011, revealed "... 6. Progress notes A. Progress notes shall be recorded on the date of observation sufficient to permit continuity of care of the patient and transfer of medical information. Whenever possible, the patient's clinical problems should be clearly identified in the progress note and correlated with specific orders as well as results of tests and treatment. Progress notes shall be written whenever the patient is seen and shall refer to the patient's clinical problems and to new and changed orders."

Review of MR15 revealed the patient was transported to a physician's office on January 26, 2012, for a cardiology follow up and again on January 30, 2012, for a neurology follow up. There was no documentation within the medical record of a progress note written recording the findings of these evaluations.

Interview with OTH1 on March 29, 2012, at approximately 1:00 PM confirmed the consulting physician was to write a progress note and return it to the facility documenting the findings of the evaluation. OTH1 confirmed there was no progress note within the medical record recording the findings of these evaluations for MR15.

Based on review of facility documents, facility policy and procedures, medical records (MR), and interviews with staff (EMP), it was determined the facility failed to ensure a physician order for transfer was present for 19 instances in nine of nine medical records reviewed (MR11, MR12, MR13, MR14, MR15, MR16, MR17, MR18, and MR19)

Findings include:

Review of the facility's "Medical Staff Rules and Regulations," dated approved November 2011, revealed "... 8. Physician Orders ... B. Written Orders: ... All orders for treatment shall include the type of treatment, specific requirements of treatment (such as wet to dry dressings, etc.) and the frequency of treatment."

Review of the facility's policy and procedure "Physician Orders, Written, Oral (TO/VO), Blanket, Range," dated reviewed August 2011, revealed "... II. Orders from ASRH (Allied Services Rehabilitation Hospital) ... Orders for patient treatment and medications, including the administration of medications, will be carried out only when given by a qualified physician, surgeon, dentist, podiatrist or other person duly licensed or authorized by the State of Pennsylvania and who has been approved as a member of the medical staff of this Hospital."

Review of the facility's policy and procedure "Continuum of Care Transferring and Transporting Patients," dated reviewed August 2011, revealed "I. Purpose To ensure that a patient transfer and/or transport provides the patient with the appropriate care, treatment, and services required for their assessed needs and to provide the receiving facility with the necessary information for continuity of care. II. Policy: 1. Arrangements will be made for the continuum of care for patient's requiring care, treatment, or services by a provider at a facility other than ASRH. ... C. Procedure: Prior to transport: 1. After discussing the test/service with the patient/family, the attending physician will order the test/service. This order will include the test/service needed, and if an ambulance is necessary..."

Review of MR11 revealed the patient was transferred to a physician's office on January 4, 2012, for a cardiology follow up appointment and on January 5, 2012, for a cardiothoracic surgery appointment. There was no documentation in MR11 of written physician orders or the required mode of transportation for these physician visits.

Review of MR12 revealed the patient was transferred to a physician's office on January 3, 2012, for an orthopedic surgical follow up appointment for cast removal appointment and on January 5, 2012, for an orthopedic follow up appointment. There was no documentation in MR12 of written physician orders or the required mode of transportation for these physician visits.

Review of MR13 revealed the patient was transferred to a podiatrist's office on January 23, 2012, and January 30, 2012, for a follow up podiatric surgical appointments. There was no documentation in MR13 of written physician orders or the required mode of transportation for these physician visits.

Review of MR14 revealed the patient was transferred to a physician's office on February 9, 2012, for a follow up infectious disease appointment and on February 15 and 22, 2012, for wound care appointments. There was no documentation in MR14 of written physician orders or the required mode of transportation for these physician visits.

Review of MR15 revealed the patient was transferred to a physician's office on January 26, 2012, for a follow up cardiology appointment and on January 30, 2012, for follow up neurology appointment. There was no documentation in MR15 of written physician orders or the required mode of transportation for these physician visits.

Review of MR16 revealed the patient was transferred to a physician's office on February 22, 2012, and March 1, 2012, for follow up trauma clinic appointments. There was no documentation in MR16 of written physician orders or the required mode of transportation for these physician visits.

Review of MR17 revealed the patient was transferred to a physician's office on February 6, 2012, and March 1, 2012, for follow up podiatric surgical appointments. There was no documentation in MR17 of written physician orders or the required mode of transportation for these physician visits.

Review of MR18 revealed the patient was transferred to a physician's office on February 28, 2012, and March 13, 2012, for follow up orthopedic appointments. There was no documentation in MR18 of written physician orders or the required mode of transportation for these physician visits.

Review of MR19 revealed the patient was transferred to a physician's office on January 9 and 20, 2012, for wound care appointments. There was no documentation in MR19 of written physician orders or the required mode of transportation for these physician visits.

Interview with OTH1 on March 29, 2012 at approximately 1:30 PM confirmed no physician orders were written for these follow up physician visits. OTH1 confirmed there was no physician order for the required mode of transportation for these physician visits.