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 531311 (X3) Date Survey Completed 09/29/2016
Name of Provider or Supplier Crook County Hospital Street Address, City, State 713 Oak Street, Sundance, 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)
C0339 QUALITY ASSURANCE
CFR(s): 485.641(b)(3)

[The program requires that--] the quality and appropriateness of the diagnosis and treatment furnished by nurse practitioners, clinical nurse specialists, and physician assistants at the CAH are evaluated by a member of the CAH staff who is a doctor of medicine or osteopathy or by another doctor of medicine or osteopathy under contract with the CAH;


This STANDARD is not met as evidenced by:
Based on staff interview and review of medical records. The facility staff list, and quality assurance (QA) meeting minutes, the facility failed to ensure the QA program evaluated physician oversight of mid-level practitioner services. The facility included 7 mid-level practitioners. The findings were: Review of 20 medical records (#1 - #20) showed each had received some care from a mid-level practitioner. Review of the list of physicians and mid-level practitioners showed the facility staff included 4 nurse practitioners, 2 advanced practice registered nurses, and 1 physician assistant. The following concerns were identified: a. Medical record review for 20 sample patients showed no evidence a physician reviewed mid-level practitioner services provided. b. Review of QA meeting minutes for 10/7/15, 11/10/15, 12/29/15, 1/26/16, and 7/14/16, showed no evidence services provided by mid-level practitioners were reviewed by a physician. c. Interview with the DON on 9/29/16 at 11:40 AM confirmed the QA committee failed to ensure a physician provided oversight concerning the services provided by mid-level practitioners.