HospitalInspections.org

Based on review of documents and staff interview, the hospital failed to provide a patient with a written response regarding the resolution of a grievance. This deficient practice affected one (1) of ten (10) patients (patient #1). This has the potential to limit a patient's right to have a grievance resolved in an appropriate fashion and limits the right to receive required written notification of the hospital's decision. Findings include:

1. The Quantros (complaint) Feedback Form dated 7/22/2010 indicated the hospital received the patient #1's complaint regarding her care including a request for a response to her concerns.

2. Although the Nurse Manager spoke with the patient (by telephone on 7/22/10) regarding her concerns and that she would be "discussing this with the RN", there was no evidence a written response was sent to the patient as to the resolution of the grievance.

3. The hospital's Administrative Policy Manual reviewed/revised 2010 indicates in part as follows: "a grievance is a formal or informal written or verbal complaint ...made by a patient...regarding the patient's care ....., abuse ....issues related to the hospital's compliance with the CMS Hospital Conditions of Participation ......" .

4. During interview with an Assistant Compliance Officer and the Director of Nursing Quality (throughout the survey), they agreed the patient did not receive a written response to her grievance.

Based on review of documents, medical records and staff interview, a patient was not provided with adequate accomodation to help prevent a patient fall. This deficient practice affected one (1) of ten (10) patients (patient #1). This has the potential to increase the likelihood of patient injury. Findings include:

1. The medical record for patient #1 indicated the patient was 5 ft. 2" and weighed 210 lbs. The record documented the patient was given Lactulose and Mag Citrate and was at risk for falls. However, there was no evidence a bedside commode was provided for the patient. When she pushed her call light "and no one would come for 15 to 20 minutes" she tried to make it to the bathroom without assistance. During this attempt to use the bathroom, she did not make it, soiled herself and then slipped and fell while in the bathroom, hitting her knee.

2. The medical record indicated the patient's bed alarms were not "hooked up" until after she fell.

3. A review of the Safety Events Log in the reporting period of 7/1 - 8/30/10 indicated the following (in part), "pt. found sitting in bathroom floor on coccyx crying incontinent of stool all over bathroom floor. States she was trying to get to commode".

4. These findings were reviewed with the Assistant Compliance Officer and the Director of Patient Quality on 9/1/10 in the a.m. without disagreement.

Based on review of documents, medical record and staff interview, the hospital failed to provide a patient the right to be free from verbal abuse. This deficient practice affected one (1) of ten (10) patients (patient #1). This has the potential to negatively affect the patient and to limit the quality of patient care. Findings include:

1. A review of patient #1 medical record nursing notes dated 7/18/10 (19:50 hrs.) reflect the RN caring for the patient documented (in the medical record) the patient was a "VERY nasty, irritable and obnoxious individual". There was no evidence the patient had obtained a copy of the medical record, yet, the statement corresponded very closely with the allegations submitted to the State Agency indicating the patient had heard them directly.

2. A review of the The Patients Bill of Rights and Responsibilities (revised 3/2009) indicated as number one, "the patient has the right to considerate and respectful care". Evidence indicates the staff nurse did not follow the hospital's "Bill of Rights and Responsibilities".

3. During interview with the Nurse Manager on 8/31/10 in the a.m., she reviewed the medical record and what the Staff Nurse had written in her notes and agreed the language was very inappropriate. She also said she counseled the nurse, but did not review the medical record documentation by the staff nurse prior to counseling the nurse.

4. These findings were reviewed with the Assistant Compliance Officer and the Nursing Director of Quality on 9/1/10 in the a.m., without disagreement.

Based on review of documents, medical records and staff interview, the Nurse Manager failed to execute adequate preparation prior to counseling a staff nurse in order to improve her performance and to resolve an inappropriate nurse/patient encounter. This has the potential to limit the employee's opportunity to change her behavior and limit the performance improvement process. Findings include:

1. The QA/PI Program shows evidence its scope is broad and that quality indicators are used throughout the departments and health outcomes are being monitored via the utilization of various quality indicators. The hospital monitors safety issues and maintains a Falls Task Force which monitors all falls and gives special attention to those falls resulting in injury. Patient #1's fall was included in the patient falls matrix.

2. However, the hospital's effort to investigate this complaint of verbal abuse and to take effective corrective action was limited. During interview with the 3 South Nurse Manager on 8/31/10 in the p.m., she indicated she had spoken with the nurse who (allegedly) verbally abused the patient. When asked if she had reviewed the medical record as to what the nurse wrote in her nurses' notes and whether she addressed those issues with the nurse, she said she did not review the chart before she counseled the nurse and that she did not address all the issues documented in the medical record. This omission limited the manager's effectiveness in her effort to improve the nurse's performance.

3. These findings were reviewed with the Assistant Compliance Officer and the Director of Nursing Quality on 9/1/10 in the a.m. without disagreement.

Based on medical record review and staff interview, the hospital failed to ensure the nursing staff signed-off physician orders appropriately with a full name, date and/or time in ten (10) of ten (10) medical records (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10) reviewed. This has the potential to negatively impact all patient care by not providing an accurate timeline of when orders were received and care provided. Findings include:

1. Review of the medical record for Patient #1 revealed the patient was admitted 7/12/10 and discharged 7/20/10. During the entire hospital stay, there were numerous physician orders (written, verbal and telephone) signed-off by nursing staff without the date and/or time.

2. Review of the medical record for Patient #2 revealed the patient was admitted 7/10/10 and discharged 7/14/10. During the entire hospital stay, there were numerous physician orders (written, verbal and telephone) signed-off by nursing staff without the date and/or time.

3. Review of the medical record for Patient #3 revealed the patient was admitted 7/19/10 and discharged 7/23/10. During the entire hospital stay, there were numerous physician orders (written, verbal and telephone) signed-off by nursing staff without the date and/or time. The patient's discharge orders on 7/23/10 at 1532 were not signed-off at all.

4. Review of the medical record for Patient #4 revealed the patient was admitted 7/11/10 and discharged 7/14/10. During the entire hospital stay there were numerous physician orders (written, verbal and telephone) signed-off by nursing staff without the date and/or time. Physician orders written 7/14/10 at 0800 and 1230 were not signed-off at all.

5. Review of the medical record for Patient #5 revealed the patient was admitted on 7/18/10 and discharged on 7/22/10. During the entire hospital stay there were numerous physician orders (written, verbal and telephone) signed-off by nursing staff without the date and/or time.

6. Review of the medical record for Patient #6 revealed the patient was admitted on 7/10/10 and discharged on 7/15/10. During the entire hospital stay there were numerous physician orders (written, verbal and telephone) signed-off by nursing staff without the date and/or time. Physician order dated 7/12/10 and 7/13/10 were not signed-off at all.

7. During an interview with the Director of Nursing (DON) in the morning of 9/2/10, the records (patient #1, 2, 3, 4, 5 and 6) were reviewed and the DON agreed with the above findings.

8. Review of the medical record for Patient #7 revealed the patient was admitted on 8/31/10. During record review in the morning of 9/2/10, there were numerous physician orders (written, verbal and telephone) signed-off by nursing staff without the date and/or time.

9. Review of the medical record for Patient #8 revealed the patient was admitted on 8/31/10. There was no documented evidence of nursing staff signing-off the patient's Admission Orders dated 8/31/10 at 1450.

10. Review of the medical record for Patient #9 revealed the patient was admitted on 8/29/10. During record review in the morning of 9/2/10, there were numerous physician orders (written, verbal and telephone) signed-off by nursing staff without the date and/or time. Physician orders dated 8/30/10 at 1740 were not signed-off at all.

11. Review of the medical record for Patient #10 revealed the patient was admitted on 9/1/10. During record review in the morning of 9/2/10, there was no documented evidence of nursing staff signing-off the Admission Orders dated 9/1/10.

12. The Unit Manager was present during record review of Patients #7, 8, 9 and 10. The Unit Manager agreed with the above findings.

Based on medical record review and staff interview, the hospital failed to ensure the medical staff authenticates telephone and/or verbal orders within forty-eight (48) hours in four (4) of six (6) closed medical records (Patients #1, 2, 5, 6) reviewed. This has the potential to negatively impact all patient care by the physician(s) not being able to identify transcription errors and potential patient safety risks in a timely manner. Findings include:

1. Review of the medical record for Patient #1 revealed the patient was admitted 7/12/10 and discharged 7/20/10. During the entire hospital stay, there were numerous physician telephone and/or verbal orders authenticated greater than forty-eight (48) hours after being given.

2. Review of the medical record for Patient #2 revealed the patient was admitted 7/10/10 and discharged 7/14/10. During the entire hospital stay, there were numerous physician telephone and/or verbal orders authenticated greater than forty-eight (48) hours after being given.

3. Review of the medical record for Patient #5 revealed the patient was admitted on 7/18/10 and discharged on 7/22/10. During the entire hospital stay, there were numerous physician telephone and/or verbal orders authenticated greater than forty-eight (48) hours after being given. Also, there is no documented evidence of authentication of a telephone order dated 7/18/10 at 0710.

4. Review of the medical record for Patient #6 revealed the patient was admitted on 7/10/10 and discharged on 7/15/10. During the entire hospital stay, there were numerous physician telephone and/or verbal orders authenticated greater than forty-eight (48) hours after being given.

5. During an interview with the Director of Nursing (DON) in the morning of 9/2/10, the records were reviewed and the DON agreed with the above findings.