| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 531310 | (X3) Date Survey Completed 05/03/2012 |
| Name of Provider or Supplier Powell Valley Hospital | Street Address, City, State 777 Avenue H, Powell, WY | |
| For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency. | ||
| (X4) ID Prefix Tag | Summary Statement of Deficiencies
(Each deficiency should be preceded by full regulatory or LSC identifying information) |
| C0320 | SURGICAL SERVICES CFR(s): 485.639 If a CAH provides surgical services, surgical procedures must be performed in a safe manner by qualified practitioners who have been granted clinical privileges by the governing body, or responsible individual, of the CAH in accordance with the designation requirements under paragraph (a) of this section. This CONDITION is not met as evidenced by: Based on observation, medical record review, staff interview, review of policies and procedures, and review of credentialing files, the facility failed to ensure the necessary surgical policies and procedures were developed and implemented (C271), failed to obtain appropriate informed consents (C304), failed to provide evidence of appropriate post-anesthesia evaluations (C322) and failed to designate personnel allowed to administer anesthesia (C323). In addition, the facility failed to indicate which endoscope passed or failed the pass/fail test and to track individual patient usage of endoscopes (C271). The cumulative effect of these deficiencies resulted in a determination that the facility failed to promote a safe surgical environment and, therefore, failed to meet the requirements for the condition of participation for surgical services. |