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Based on record review and interview, the hospital failed to ensure the patient received care in a safe setting. This deficient practice is evidenced by the hospital failing to remove unsafe items in reach of a patient admitted under a Physicians Emergency Certificate (PEC).
Findings:

A review of hospital policy, "Contraband," Policy No. SAF-24 with an effective date of 07/15/2020, revealed in part, IV. Definitions: A. Contraband: Any items that can be utilized as a weapon or otherwise post a threat or jeopardize the health or well-being of any team member, patient or guest of the facility. This also included any instrumentality that can jeopardize a patient's therapeutic plan of care. 1. Examples of Contraband include: Item v. Medicine brought from home (prescription or over the counter). VI. Handling Contraband: 1. Contraband items cannot be used by the patient on suicide precautions except under the direct supervision by staff. 2. Medication brought from home cannot be left with the patient.

A review of hospital policy, " ... Care of the PEC/CEC/JC/OPC Patient," PolicyStat ID 14929730, with an effective date of 12/2023, revealed in part, Attachment A - Safety Precautions: The following safety precautions will be implemented for all PEC, CEC, and JC patients. II. Patients will undress completely and be observed specifically for sharp or metal objects, matches/lighters, and medication contraband. IV. All patient's belongings (clothing, shoes, jewelry, cell phone, etc.) will be removed from the room and secured.

A review of Patient #3's electronic medical record (EMR) revealed the patient presented to the emergency department (ED) initially complaining of suicidal ideation with the provider indicating, " ... his speech is completely nonsensical." It was also noted the patient was diaphoretic, tachycardic, disoriented and holding a bottle of Delsym. As time progressed in the ED the patient indicated he drank the entire bottle (148 ml) that morning. The ED Provider placed the patient under a Physician Emergency Certificate (PEC) for danger to self and gravely disabled on 06/02/2024 at 6:00 p.m. However, the provider was not able to medically clear the patient because of physical findings. Patient #3 was transferred to the hospital's main campus intensive care unit (ICU) on 06/02/2024 at approximately 11:30 p.m. Initial admission nursing assessment on 06/02/2024 at 11:36 p.m. revealed patient place on PEC/CEC/Suicidal Precautions, room check performed, placed in paper scrubs/gown, staff supervision was assigned for suicidal/homicidal, 1:1 observation and room close to nursing station. However, there was no documentation related to the possession and current status of the patient's belongings. The patient was transferred to Room #a on 06/03/2024 at approximately 4:07 p.m. A review of the incident report dated 06/10/2024 revealed in part, the team transporting Patient #3 to Room #a left Patient #3's belongings in the room. A nursing note from 06/03/2024 at 5:00 p.m. revealed S7LPN documenting, " ... found patient in bathroom with a bottle of Delsym drinking the contents ...patient said he drank about ¼ of the bottle ..."

In an interview on 06/26/2024 at 12:00 pm, S6Sit confirmed she was the sitter present prior to and after the patient was transferred from ICU to Room #a. S6Sit also confirmed the patient's belongings were stored in a belongings bag in the patient's ICU room, the belongings accompanied the patient in transfer to 5-west, and the belongings were left at the bedside upon the patient's arrival to Room #a. The sitter further confirmed she witness the patient rummaging through the belongings bag and obtaining the bottle prior to going into the restroom. She then notified the nursing staff of the patient having obtained a bottle from his belongings bag prior to entering the restroom.

In an interview on 06/26/2024 at 12:17 a.m., S7LPN confirmed she was the receiving nurse on 5-west and she had not assessed the patient prior to the above mentioned event. She further confirmed she was unaware the patient remained in possession of his personal belongings.

Based on record review and interview, the hospital failed to ensure patients were kept free of all forms of abuse or harassment. This deficient practice is evidenced by the hospital failing to report allegations of potential abuse/neglect to LDH-HSS (Louisiana Department of Health - Health Standards Section).
Findings:

Review of the Louisiana Revised Statutes, Title 40. Public Health and Safety, Chapter 11, State Department of Health and Hospitals revealed "Department" shall mean the Department of Health and Hospitals. "Unit" means the Medicaid fraud control unit created within the office of criminal law of the Department of Justice and which is certified by the secretary of the United States Department of Health, Education and Welfare. Regarding §2009.20. Duty to make complaints; penalty; immunity, "Abuse" is the infliction of physical or mental injury or the causing of the deterioration of a consumer by means including but not limited to sexual abuse, or exploitation of funds or other things of value to such an extent that his health or mental or emotional well-being is endangered. "Neglect" is the failure to provide the proper or necessary medical care, nutrition, or other care necessary for a consumer's well-being. Any person who is engaged in the practice of medicine, social services, facility administration, psychological or psychiatric services; or any registered nurse, ... having knowledge that a consumer's physical or mental health or welfare has been or may be further adversely affected by abuse, neglect, or exploitation shall, within twenty-four hours, submit a report to the department or inform the unit or local law enforcement agency of such abuse or neglect. When the department receives a report of sexual or physical abuse, whether directly or by referral, the department shall notify the chief law enforcement agency of the parish in which the incident occurred of such report. Such notification shall be made prior to the end of the business day subsequent to the day on which the department received the report.Pursuant to LA R.S. 40:2009.20 facilities/health care workers shall report these allegations within 24 hours of receiving knowledge of the allegation to either the local law enforcement agency or the Department of Health and Hospitals (LDH) (or the Medicaid Fraud Unit as applicable). For the purposes of this process Health Standards, the Louisiana Department of Health (LDH) Legal Services Division, and the Office of the Attorney General have interpreted this to mean that the 24-hour time frame begins as soon as any employee or contract worker at the facility (including physicians) becomes aware that an incident of abuse/neglect has been alleged, witnessed, or is suspected, regardless of the source of information and regardless of the existence or lack of supporting evidence.

A review of hospital policy, "Contraband," Policy No. SAF-24 with an effective date of 07/15/2020, revealed in part, IV. Definitions: A. Contraband: Any items that can be utilized as a weapon or otherwise post a threat or jeopardize the health or well-being of any team member, patient or guest of the facility. This also included any instrumentality that can jeopardize a patient's therapeutic plan of care. 1. Examples of Contraband include: v. Medicine brought from home (prescription or over the counter). VI. Handling Contraband: 1. Contraband items cannot be used by the patient on suicide precautions except under the direct supervision by staff. 2. Medication brought from home cannot be left with the patient.

A review of hospital policy, " ... Care of the PEC/CEC/JC/OPC Patient," PolicyStat ID 14929730, with an effective date of 12/2023, revealed in part, Attachment A - Safety Precautions: The following safety precautions will be implemented for all PEC, CEC, and JC patients. II. Patients will undress completely and be observed specifically for sharp or metal objects, matches/lighters, and medication contraband. IV. All patient's belongings (clothing, shoes, jewelry, cell phone, etc.) will be removed from the room and secured.

A review of hospital policy, " ...Abuse and Neglect: Identifying and Reporting Cases," Policystat ID 14916859, with an effective date of 12/2023, revealed in part, Purpose: To outline guidelines and responsibilities related to identifying and reporting suspected cases of child, adult, and elderly abuse and neglect consistent with the laws of the State of Louisiana. Definition: Neglect-The failure, by caregiver responsible for an adult's care or by other parties, to provide the proper or necessary support or medical, surgical, or any other care necessary for his well-being. Policy: Any incident of allegations and/or suspicion of abuse/neglect occurring within the facility will follow a Self-Reporting Process for Hospitals Abuse/Neglect in accordance with Louisiana Department of Health. Procedure: Self-Report Knowledge of Incidents of Allegations and/or Suspicion of Abuse/Neglect within the Facility: a. Any allegation and/or suspicion of abuse or neglect will be self-reported to the LDH. b. Hospital facilities/health care workers will report these allegations within 24 hours of receiving knowledge of the allegation. c. The 24-hour time frame begins as soon as any employee or contract worker at the facility (including physicians) becomes aware that an incident of abuse/neglect has been alleged, witnessed, or is suspected, regardless of the source of information and regardless of the existence or lack of supporting evidence. Director/Supervisor/Administrative Representative must Immediately: f. Forward final investigative report and any requested documents to the appropriate LDH contact within 5 business days from the email acknowledging submission of the initial report.

A review of the hospital's incident logs revealed an incident of self-harm/self-inflicted injury on Patient #3. A review of Patient #3's electronic medical record (EMR) revealed the patient was admitted and under a PEC. Initial admission nursing assessment on 06/02/2024 at 11:36 p.m. revealed patient place on PEC/CEC/Suicidal Precautions, room check performed, placed in paper scrubs/gown, staff supervision was assigned for suicidal/homicidal, 1:1 observation and room close to nursing station. However, there was no documentation related to the possession and current status of the patient's belongings. The patient was transferred to 5-west med/surg unit on 06/03/2024 at approximately 4:07 p.m. A review of the incident report dated 06/10/2024 revealed in part, the team transporting the Patient #3 to Room #a left Patient #3's belongings in the room. A nursing note from 06/03/2024 at 5:00 p.m. revealed S7LPN documenting, " ... found patient in bathroom with a bottle of Delsym drinking the contents ...patient said he drank about ¼ of the bottle ..."

In an interview on 06/26/2024 at 12:00 pm, S6Sit confirmed she was the sitter present prior to and after the patient was transferred from ICU to Room #a. S6Sit also confirmed the patient's belongings were stored in a belongings bag in the patient's ICU room, the belongings accompanied the patient in transfer to 5-west, and the belongings were left at the bedside upon the patient's arrival to Room #a. The sitter further confirmed she witness the patient rummaging through the belongings bag and obtaining the bottle prior to going into the restroom. She then notified the nursing staff of the patient having obtained a bottle from his belongings bag prior to entering the restroom.

In an interview on 06/26/2024 at 12:17 a.m., S7LPN confirmed she was the receiving nurse for Patient #3 and she had not assessed the patient prior to the above mentioned event. She further confirmed she was unaware the patient remained in possession of his personal belongings.

In an interview on 06/25/2024 at 2:55 p.m., S3DPSQ and S5AS confirmed the above mentioned findings and the incident should have been reported to LDH-HSS in accordance with the Self-Reporting Process for Hospitals Abuse/Neglect.

Based on record review and interview, the hospital failed to ensure the nursing staff developed and kept current a nursing care plan that reflected the patient's goals and the nursing care to be provided to meet the patient's needs. This deficient practice was evidenced by the hospital failing to develop a nursing care plan on 1 (#3) of 3 (#1 - #3) patients that encompasses all of the patient's current medical and psychological needs.
Findings:

A review of hospital policy, "Planning of Daily Care," Volume I (ST-03), with an effective date of 09/17/1985 and last reviewed on 02/17/2002, revealed in part, General: 2. When a patient is admitted, an RN performed an initial nursing assessment within the appropriate time-frame. The information obtained at the time of the assessment is transferred to the patient's individual plan of care. The patient's plan of care facilitates the following objectives: a. To ascertain a systematic, concise and organized approach to patient care. b. To provide a means through which patient care standards are utilized in the nursing care process. c. To communicate relevant data rapidly and efficiently to other members of the health care team. d. To plan individualized care based upon patient problems identified through assessment. e. To assure quality care based upon medical and nursing orders. f. To provide a basis for evaluating patient care through nursing actions and patient responses. 4. Nursing Plan of Care will be initiated by the Nurse

A review of hospital policy, " ... Suicide Screening, Assessment and Management of Patients at Risk (Non-Behavioral Health Units)," PolicyStat ID 15022705, with an effective date of 02/2024, revealed in part, Purpose: To outline the guidelines and responsibilities related to managing the care of patients at risk for suicide, self-harm, and/or harm to others and to assist with theidentification of patients who are at risk for suicide, ensuring a safe environment for the provision of care. Procedure: J. The patient's care plan will be updated, ensuring patient-centered care by engaging the person at risk in care planning and decision making.

A review of Patient #3's electronic medical record (EMR) revealed the patient presented to the emergency department (ED) initially complaining of suicidal ideation with the provider indicating, " ... his speech is completely nonsensical." It was also noted the patient was diaphoretic, tachycardic, disoriented and holding a bottle of Delsym. The ED Provider placed the patient under a Physician Emergency Certificate (PEC) for danger to self and gravely disabled on 06/02/2024 at 6:00 p.m. A review of the care plan did not reveal any problem related to self-harm or suicide related precautions.

In an interview on 06/26/2024 at 11:25 a.m. S5AS confirmed the above mentioned findings.