AFT2 Task 3 / Tracer Patient
In reviewing the Surgical Patient Tracer Worksheet (SPTW), it was found that a deficiency was noted that stated “History and physical not done within 24 hours of admission (> 72 hours).” This meant that the laparoscopic hysterectomy related History and Physical (H&P) the patient received was used for the abdominal hysterectomy. Plus, it was more than seventy-two hours after being admitted to NCH for surgery that the patient received the H&P for the abdominal hysterectomy. In reviewing the Tracer document and other information, it became clear that there were three violations of Joint Commission Standards (JCS) for PC.01.02.03 which ...view middle of the document...
The H&P was actually performed more than seventy-two hours after admission and twenty-four hours after the surgery was completed. This violation relates to JCS PC.01.02.03 EP 4 states: “The patient receives a medical history and physical examination no more than 30 days prior to, or within 24 hours after, registration or inpatient admission, but prior to surgery or a procedure requiring anesthesia services.” (Joint Commission, 2014 August).
3) Finally, although there is no mention of the Anesthesiologist, the Anesthesiologist is also at fault for a lack of performance. As noted in both the laparoscopic and abdominal hysterectomy definitions, anesthetics are used during each procedure. Even if no one else on the surgical staff requested a new H&P, the Anesthesiologist was obligated to request a new H&P once the bleeding was discovered and was to result in a change in patient condition (bleeding) prior to a surgery requiring the administration of anesthesia. This failure violated JCS PC.01.02.03 EP 5 which states: “For a medical history and physical examination that was completed within 30 days prior to registration or inpatient admission, an update documenting any changes in the patient's condition is completed within 24 hours after registration or inpatient admission, but prior to surgery or a procedure requiring anesthesia services.” (Joint Commission, 2014 August).
To summarize, first, neither the doctor nor the staff ordered a new H&P when the patient’s surgical status changed due to the continuous loss of blood. Second, the surgeon did not request a new H&P when the less invasive laparoscopic hysterectomy was changed to the more invasive abdominal hysterectomy. Finally, the Anesthesiologist did not ask for a new H&P when he performed his review possible changes in anesthetics due to both the bleeding and the switch to abdominal surgery. Luckily for NCH the patient did not bleed to death which could have resulted in the Surgeon and the Anesthesiologist having their licenses revoked, multi-million dollar lawsuits, loss of insurance coverage, and loss of accreditation by the Joint Commission. As it is NCH may be liable for a malpractice lawsuit due to not following Joint Commission procedures that are designed to protect the health of all patients.
A Surgical Corrective Action Plan Committee (SCAPC) will be put together by NCH made up of a select group of our Attorneys and medical staff from each specialty with the objective of coming up with answers for two major goals. The first goal is to lessen the chance or at least minimalize the financial impact of liability litigations by developing better policy guidance. In all cases, the financial bottom line will always be the most important factor in the running of any business and will remain so for NCH.
Second, better policy guidance will come in the form of a new Surgical H&P policy letter that will include a statement similar to the following...