HospitalInspections.org

Based on interview and record review, hospital staff failed to ensure a voluntary patient's request for discharge from the psychiatric unit was addressed per hospital policy and procedure for 1 of 3 patients reviewed [Patient #1].

Findings Included:

1) The physician discharge summary dated 11/30/09 reflected, Patient #1 "was admitted voluntarily to the psychiatric unit on 11/26/09 with depressive disorder and suicidal ideations. The patient came in because of problems with depression ...and a major problem with gambling... he initially minimized his issues ...he did not think he had any problems, he did not need any major treatment and he had to return to his two jobs and take care of his business ...the patient was redirected multiple times ..."

The admission orders dated 11/26/09 timed at 0200 reflected Patient #1 was placed on q 15 min for self harm and close observation ...started on Zoloft 50 mg at 1:10 PM and increased to 100 mg on 11/28/09 ...the 11/30 orders reflected, " discharge home telephone order from physician at 0850."

The physician progress notes dated 11/26/09 to 11/30/09 reflected no documentation indicating Patient #1 wanted to be discharged.

The interdisciplinary progress note dated 11/28/09 timed at 1515 reflected, "patient ...stated I have just got to leave, I can't stay here any longer...this nurse explained policy/procedure for discharge ...patient frustrated ...the note timed at 2020 reflected, patient states I just don't belong here ...I need to go home to take care of my real estate business ...support offered ...the note dated 11/29/09 timed at 0900 reflected, no suicidal thoughts ...does not think he needs to be here ...the note dated 11/30/09 timed at 0810 reflected, patient states he regrets coming here because he wants to leave and and states he needs to take care his business ...Dr. notified ...at 1010 patient discharged home and aftercare planned discussed with patient."

Daily therapy documentation dated 11/29/09 reflected under section entitled, "process group ...patient in day area and did not come to group ...patient wanting to discharge." No further documentation was found indicating the therapist addressed Patient #1's request to discharge.

On 05/12/10 at 1:10 PM Personnel #6 was interviewed. Personnel #6 was asked by the surveyor to review her therapy notes. Personnel #6 stated she did not remember the patient and reviewed her progress note where Patient #1 verbalized his request to be discharged. Personnel #6 stated she did not remember what she did. Personnel #6 stated she should of notified the nurse so the Demand for Release form could be completed and the physician notified.

On 05/13/10 at 10:15 AM RN #8 was interviewed. RN #8 was asked to review her nursing notes dated 11/28/09. RN #8 stated she did not remember the patient. RN #8 was asked what the procedure is when a patient requests to be discharged. RN #8 stated the patient is given the Demand for Release form and nursing staff explain the physician is notified and the doctor has 4 hours to release the patient or the physician may decide to keep them. RN #8 was asked where the demand for release form was and whether she completed one for Patient #1. RN #8 stated there was no completed form in the chart and she did not document everything she did.

The basic rights for all patients provided to Patient #1 reflected, "voluntary patients...you have right to request discharge from the hospital if you want to leave, you need to say so in writing or tell a staff person. If you tell a staff person you want to leave, the staff person must write it down for you ...you have a right to be discharged from the hospital within four hours of requesting discharge ...only three reasons why you would not be discharged. 1) change your mind and stay. 2) If you are under 16 and the person who admitted you does not want you to leave. 3) May be detained longer than 4 hours if your doctor has reason to believe you might meet criteria for court-ordered services or emergency detention ..."

The hospital policy entitled, "Demand for release/discharge against medical advice " with a revision date of 07/07 reflected, "the patient who is requesting premature discharge signs the Demand for Release form. Staff complete the form for those patients who refuse or cannot sign. The patient is advised that they are released within four hours unless the physician indicates the intent to evaluate the patient for an application for court ordered mental health services ..." No documentation was found in the medical record indicating Patient #1 was provided with a demand for release form.