MARION - Heartland Regional Medical Center in Marion has submitted a Plan of Correction to the Centers for Medicare & Medicaid Services in Chicago as a fallout from a baby-switching incident in late March.

In documents received Wednesday from CMS Principal Program Representative Heather Lang, through a Freedom of Information Act request, Heartland addressed key concerns in great detail.

CMS, for example, said the hospital must have an organized nursing service that provides 24-hour nursing services and those services must be furnished or supervised by a registered nurse.

The hospital's response as provided by spokeswoman Staci Bynum was that all caregivers involved in the switching incident were RNs, therefore the care was furnished and supervised by an RN.

The Chief Nursing Officer met with staff after the incident and reviewed updated protocol, which was implemented immediately and listed below:

• Ask the mother to read all the information on her band and the nurse will verify that all the information is correct

• Two bands must be present on the baby at all times. There will be no taping of bands to the crib.

If one band comes off, re-band using the neonatal band system. Two RNs must verify and sign the new band.

If all bands are off, an immediate verification and matching of all present mothers and babies in the obstetrics unit must take place. Then, the mother and baby in question may be re-banded with new bands.

• Obtain a doctor's order before doing anything, including starting IVs, dispensing medicine and document all steps through the chain of command.

• Time outs must be done on each surgical procedure.

• Only one baby, one doctor and one circumcision at a time.

• Crib cards are a souvenir only.

• The RN whose mother/baby couplet requires a circumcision will be the same RN who does the time out, accompanies the baby to the surgery and assists the physician with the surgery. That RN is also responsible for band verification and the time out.

Concerning operating room policies, Lang said surgical services must be consistent with needs and resources. Policies governing surgical care must be designed to assure the achievement and maintenance of high standards of medical practice and patient care.

Bynum's response was that 100 percent of OB clinical staff will have completed an online learning module for time outs by Thursday of this week. Moreover, all OB clinical staff will read and sign the hospital's Operative and Invasive Procedure Site Verification policy and procedure.

Thirty circumcisions a month will be observed for the next four months to insure time outs are performed according to the hospital's policy and procedure.

Concerning patients' rights, Lang stated that the patient has the right to receive care in a safe setting.

Bynum said education pertaining to the mother/baby matching process was developed and posted in each patient room and added to the ante partum visit information. She said a new five-band system has been implemented, which includes an ID-numbered cord clamp and more in-depth processes for initial, ongoing, rebanding and transferring in and out of the facility and discharge.

Additionally, all licensed staff and medical staff attending deliveries were in-serviced and all OB-licensed staff participated in a return demonstration skills lab for initial, ongoing, rebanding and discharge of an infant and mother.

john.homan@thesouthern.com / 351-5805