HospitalInspections.org

Based on review of Policy, Procedure, clinical record review, hospital grievance/complaint log, and interview with hospital staff the hospital failed to adhere to internal Policy/Procedure in resolving a complaint/grievance.

Findings include:

Reviewed eight (8) clinical records (P1, P2, P3, P4, P5, P6, P7, P8) for patients admitted to in-patient care through the Emergency Department (ED).

Reviewed the hospital's documentation of complaints/grievances which revealed a complaint/grievance had been filed on behalf of P5.

A "Providence Complaint Case" form documents the intake of the complaint related to P5; initial date on form is documented as 3/15/2010, incident date is documented as 3/13/2010, concern field documented as: "dissatisfaction with personnel".
Hospital's "Contact Log Case Report" documented activities related to the complaint/grievance for P5 as: 03/15/2010, Contact mode: telephone, documented by I1, "Says he/she shouldn't be charged for 2 antibiotic in ED, since one wasn't necessary. I said I would have the business office take care of the cost of all his/her ED meds. He/she continued to express complaints. I said 'What do you want Mr/ Mrs [name]?' He/she said 'I want an apology for the terrible care I got, and for you guys not doing anything more that just a CT (CAT scan) on my abdomen.' I had already told him/her I was sorry he/she felt his/her care was so poor, and repeated this. RBO (Regional Business Office) notified to write off cost of ED meds."
Contact on 05/10/2010 is documented as: "...Mr/Mrs[name] had called her with complaints that no one had ever contacted him/her about the letter he/she had sent to [name] Providence Regional Director for Clinical Excellence complaining about his/her care at Providence Milwaukie Hospital (PMH)." (copy of letter submitted by complainant is noted to be dated on March 22, 2010)
Contact on 05/12/2010 is documented as: "Contact mode: Letter to patient." Quality Management Coordinator, Quality and Risk Management responded in a written letter dated May 12, 2010 that stated the following:

"[name], the Providence Regional Director for Clinical Excellence, received your letter in which you outlined concerns with the care you received at Providence Milwaukie in March. He/she also reviewed the investigation that was done in response to the concerns you had, including your perception that I was 'surly' when speaking with you on the telephone to discuss those concerns."

"[name of person] is aware that we did a goodwill write-off on medications you received in the emergency room. Upon reviewing all of this, [name] believes we have appropriately addressed the concerns you discussed with me, and wrote about in you letter."

When reviewed Policy titled: "Providence Health & Services Portland Service Area-Acute Care General Operating Policy, Policy No. 205.00, Subject: Patient Complaints and Grievances" stated:
"II. Policy Statement B. In the event a patient/patient's representative is dissatisfied with any aspect of their care, they will be afforded a process to express their concerns and for those concerns to be investigated and addressed.
III. Authority C. A member of the Hospital Grievance Committee, the facility Risk Manager (RM) or designee, will receive and investigate complaints and grievances....... <> If the facility RM/designee and department manager are unable to resolve the complaint/grievance within the specified timeframe or to the satisfaction of the patient or designated patient representative, the matter will be referred to the Hospital Grievance Committee.
VI. Definitions B. Complaint 5. A complaint is considered resolved when the patient or the patient's representative is satisfied with the actions taken on their behalf.
VII. Response Time Frame A. The hospital will provide a written response to the patient/patient's representative ideally within 7 business days (excludes weekends and legal holidays).
B. If the grievance is not resolved or if the investigation requires more time, the hospital will inform the patient/patient's representative that the hospital is still working to investigate/resolve the grievance and that the hospital will follow up with a written response within 7 business days from the date of this interim contact.
C. The written response is applicable to:
1. Written complaints about patient care;
2. Written or verbal complaints related to abuse or neglect issues or patient harm;
3. Written or verbal complaints related to the hospital's compliance with CMS Hospital Conditions of Participation;
4. Written or verbal complaints related to a Medicare beneficiary billing complaint related to rights and limitations provided by 42 CFR ? 489; or
5. Whenever a patient/patient's representative requests a formal review of a patient care issue.
VIII. Letter of Response Elements In the written response to the patient/patient's representative, the following elements will be included:
A. Steps taken to investigate the grievance;
B. Results of the grievance process;
C. Date of Completion - can be met by the date of the letter; and
D. Name of hospital contact person - can be met by the signer of the letter and phone number."

Letter to patient written by I1, Quality Management Coordinator, Quality and Risk Management dated May 12, 2010 failed to meet the response time frame and lacked three of four "Letter of Response Elements" outlined in the above referenced Policy.

Findings were discussed with I1, I2, I3, and I4 on 07/13/2010 at 1400.

Based on review of Policy/Procedure, clinical records, and interview with hospital staff, the hospital failed to ensure the patient's medication regimen was safe and appropriate.

Findings include:

Review of eight (8) medical records (P1, P2, P3, P4, P5, P6, P7, P8) revealed two (2) medical records had documentation in the Emergency Department (ED) of No Known Drug Allergies (NKDA) (P1, P4). Subsequent documentation in the clinical record for P1 and P4 documented an "Allergy History."

Clinical records for P5 documents in the ED Clinical Report "Known Allergies: Mycins". Medication Service portion of ED Clinical Report documented the following physician order: "Zithromax IV (intravenous): Order: Zithromax IV (Azithromycin) - Dose: 500 milligrams: Intravenous Piggyback". Medication Service portion of ED record documented: "Zithromax IV (Azithromycin) Dose: 500 milligrams: Intravenous Piggyback" as given by ED Registered Nurse (RN). Medication Service portion of ED record documented by ED RN noted: "Correct patient, time, route, dose and medication confirmed prior to administration. Patient advised of actions and side-effects prior to administration, Allergies confirmed and medications reviewed prior to administration."

When reviewed the Policy/Procedure titled: "Subject: Medication Appropriateness/Pharmacist Drug Therapy Monitoring; Number 2.006; stated: "Objective: The Pharmacy Department in conjunction with other health care providers will ensure optimal outcomes from drug therapy through an effective drug therapy monitoring program." "Procedure Statement: A. As appropriate each patient's drug therapy shall be assessed for the following: .....3. Real or potential allergies or sensitivities."

When reviewed the Policy/Procedure titled: Providence Health System PMH (Providence Milwaukie Hospital)Nursing; "Subject: Medication Administration; page 1 of 10; stated: "Policy Statements: 2. It is the responsibility of the clinician to follow professional guidelines and principles of safe practice by having awareness of the patient's noted allergies and following the "Five Rights" of medication administration before a medication is administered to a patient,
Right Medication
Right Patient
Right dose, strength and dosage form (such as extended release)
Right time
Right route."

Discussed findings with I1, I2, I3, and I4 on 07/14/2010 at 1400.

Based on review of Policy/Procedure, clinical record review, and interview of hospital staff, the hospital failed to ensure the medical record for each inpatient and outpatient is retained and accessible.

Findings include:

Eight (8) clinical records (P1, P2, P3, P4, P5, P6, P7, P8) for patients admitted to in-patient care through the Emergency Department (ED) were reviewed. Hospital maintains clinical records in an electronic health record (EHR). During the review of the EHR for P5, portions of the clinical record were not present in the EHR. These included nursing narrative notes and daily Health Status Summary.

Hospital staff provided paper copy of daily Health Status Summary for P5 on 07/15/2010. Nursing narrative notes were not accessible. I1 confirmed on 07/27/2010 that nursing narrative notes for P5 were not accessible from the EHR.

Based on review of Policy/Procedure, clinical records, and interview with hospital staff, the hospital failed to ensure the patient's medication regimen was safe and appropriate.

Please refer to the deficiency cited at A 404.