HospitalInspections.org

Based on document review the facility failed to address the nutritional needs of 1 of 1 patient reviewed. Patient #1 arrived at the facility's Emergency Room (ER) at approximately 8:45am. A regular diet was ordered at 2:38pm. The ER Registered Nurses failed to address the patient's nutritional status or act on behalf of the patient and provide food for approximately 12 hours.
A review of nursing documentation revealed on 6/3/2015 at:
8:45am patient arrived at the ER (emergency room) via EMS from the nursing home. Patient was Alert and oriented x3 upon arrival. Continuously stating "I have AIDS." Pleasant with staff, gowned and placed on monitors ..... Patient assisted to use urinal. Patient complained of "it burns when I pee." Urine clear, orange tinted .....
9:10am Emergency room M.D. at the bedside.
9:15am 20G IV established to the R ACX1(right antecubital vein with one attempt) ... .....
9:20am Emergency room M.D. at the bedside.
10:20 Patient lying in bed, continuous monitors in place. Patient periodically observed talking to self in room ... ...
11:20 Chart racked for Emergency room M.D re-evaluation. Awaiting disposition
11:40 Patient lying in bed talking to self. Continuous monitors in place. All needs met at this time, patient thankful. Will continue to monitor while awaiting disposition.
12:37 East Texas Medical Center Behavioral Health staff at bedside to assess patient for possible psych placement.
12:56 Per Lisa with University Texas Behavioral Health Center, patient not a candidate for their facility due to not having a contract with the patient's insurance provider. Stated would be speaking with Melissa, case manager RN. No change in patient's status, remains pleasant with staff.
13:50 No change in patient status, will continue to monitor while awaiting an inpatient bed.
14:50 No change in patient status. Patient remains calm and cooperative with staff. Will continue to monitor while awaiting an inpatient bed
15:21 Pharmacy called for antibiotic as ordered.
16:10 Patient attempting to sit up in bed and climb over side rails. Continues to talk to people not in the room. Patient reoriented to place and situation, Verbally encouraged to return to bed ....
16:50 Dr Castro at bedside to assess patient for admission.
17:00 Patient observed masturbating in room. Joel RN to the bedside, encouraged patient to keep self-covered for patient privacy. Patient complied .....
18:00 Patient resting calmly in bed, awaiting a sitter and inpatient bed. Will continue to monitor.
18:43 Sitter at bedside.
18:56 Report and all care to Kim RN.
19:07 Patient resting in bed. Sitter at bedside .....
The last nursing entry from the ER Nurse's notes was 19:07. The next entry was on 6/3/2015 at 21:00 (9:00pm) when the patient arrived in his hospital room #2501. The patient was provided a box meal at this time.

A review of physician orders revealed on 6/3/2015 at 14:38 (2:38pm) a regular diet was ordered for patient #1.
An interview with staff #3 confirmed the patient did not receive a snack or a meal in the ER. It was not until family arrived and complained at approximately 8:30pm did the staff address the patient #1's dietary needs.