Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391
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)
C0322 ANESTHETIC RISK & EVALUATION
CFR(s): 485.639(b)

(1) A qualified practitioner, as specified in paragraph (a) of this section, must examine the patient immediately before surgery to evaluate the risk of the procedure to be performed. (2) A qualified practitioner, as specified in paragraph (c) of this section, must examine each patient before surgery to evaluate the risk of anesthesia. (3) Before discharge from the CAH, each patient must be evaluated for proper anesthesia recovery by a qualified practitioner, as specified in paragraph (c) of this section.


This STANDARD is not met as evidenced by:
Based on medical record review, staff interview, and review of policies and procedures, the facility failed to ensure post-anesthesia evaluations were completed appropriately for 3 of 5 sample patients (#1, #16, #31) undergoing surgical procedures. The findings were: 1. According to the medical record, patient #1 underwent a surgical procedure with general endotracheal anesthesia on 4/30/12. Review of the post-anesthesia evaluation showed it was completed on 4/30/12, but no time was indicated. Further, the CRNA only wrote "[No] anes (anesthesia) probs (problems)." The evaluation failed to address the patient's level of consciousness, respiratory function, cardiovascular function, vital signs, pain, and nausea and vomiting. 2. Review of the medical record showed patient #16 underwent epidural anesthesia on 4/18/12. Review of the post-anesthesia evaluation showed "[No] anes. comp (complications)". The CRNA failed to sign the evaluation or indicate the date and time it was completed. In addition, the evaluation did not include the patient's level of consciousness, respiratory function, cardiovascular function, vital signs, and pain. 3. Review of the anesthesia record for patient #31 revealed s/he received general endotracheal anesthesia for an outpatient surgical procedure on 4/30/12. Further review showed the post-anesthesia evaluation, conducted at some unknown time on 4/30/12, failed to address the patient's level of consciousness, respiratory function, cardiovascular function, vital signs, pain, and nausea and vomiting. Instead, the CRNA had documented "[No] anes probs." 4. Review of the surgical policies and procedures showed post-anesthesia evaluations were not included. During an interview with the interim surgical nurse manager and CRNA #1, the CRNA stated the post-anesthesia evaluation was completed just before the patient was transferred to PACU. He further stated the CRNAs signed all PACU sheets but did not include the date or time of their signature. Review of the PACU sheets for the three patients listed above showed none had been signed by a CRNA. Further, signing this sheet would not meet the requirements for completing the post-anesthesia evaluation as the PACU nurse was not a practitioner qualified to administer anesthesia. Additionally, per the Centers for Medicare & Medicaid Services survey and certification letter dated January 14, 2011, the post-anesthesia evaluation "generally should not be performed immediately at the point of movement from the operative area to the designated recovery area. Rather, accepted standards of anesthesia care indicate that the evaluation should not begin until the patient is sufficiently recovered from the acute administration of the anesthesia so as to participate in the evaluation, e.g., answer questions appropriately, perform simple tasks, etc." There was no evidence the aforementioned patients could participate in the evaluation.