HospitalInspections.org

Based on records reviewed and interviews the Hospital failed to ensure for one (Patient #8) of ten medical records sampled that the Nursing Staff kept current Patient #8's Nursing Care Plan to include recommended interventions to encourage Patient #8 to take his/her antipsychotic (psychiatric) medications.

Findings included:

The Hospital policy titled, Assessment & Care Planning, undated, indicated a plan of care was updated and revised based on reassessments information.

The History and Physical, dated 8/23/17, indicated Physicians admitted Patient #8 to the Hospital from a Psychiatric Hospital for treatment of pneumonia in both lungs. The History and Physical indicated Patient #8 suffered from an exacerbation of mental illness with catatonia (unresponsiveness). The History & Physical indicated Patient #8 was refusing to take his/her antipsychotic medications.

The Medical Record indicated Rogers guardianship (a Court determined Patient #8 incapacitated and required guardianship to make medical and personal decisions) and Rogers guardianship hearing to authorize antipsychotic (psychiatric) medications.

Physician notes, dated 8/26/17 at 3:02 P.M., 8/27/17 at 12:05 P.M., 8/28/17 at 2:07 P.M., and 8/29/17 at 9:51 A.M., indicated Hospitalist #1 spoke with Patient #8's Guardian on 8/26/17 for the possible need for physical restraint for safety and medications and the Guardian agreed with the plan.

The Surveyor interviewed Hospitalist #1 at 3:40 P.M. on 10/24/17. Hospitalist #1 said that he discussed the possible need to use physical restraint to give Patient #8 his/her antipsychotic medications with Patient #8's guardian and Patient #8's guardian consented to this plan.

Nursing Notes, dated 9/1/17 at 4:03 P.M., 9/2/17 at 2:00 P.M. & 10:27 P.M., indicated Patient #8 would be restrained if he/she refused to take his/her medications.

The Surveyor interviewed the Risk Prevention Director at 4:10 P.M. on 10/14/17. The Risk Prevention Director said an Ethics Consult Plan recommended that the Nursing Staff use ice-cream, walks and fashion magazines to encourage Patient #8 to take his/her medication in an effort to avoid physical restraint.

The Ethics Consult, dated 9/6/17, indicated identified interventions to manage Patient #8's frequent refusal to take his/her medications due to his/her fear and paranoia included using a direct approach and limit negotiating such as Patient #8's own clothes and personal items from home to normalize his/her environment, encouraging walks in the hall, Patient #8's enjoyment of fashion magazines, classical music and all kinds of ice-cream.

The Assessment & Care Planning Policy indicated the plan of care was customized (individualized) based on interventions.

The Risk Prevention Director said the Nursing Staff did not individualize Patient #8's Nursing Care Plan (to include the use of ice-cream, walks and fashion magazines as encouragement for Patient #8 to hake his/her medication).

The Nursing Care Plan, dated 9/15/17 at 2:34 A.M., did not indicate the identified nursing interventions to use ice-cream, walks or fashion magazines as activities to encourage Patient #8 to take the antipsychotic medications for treatment of Patient #8's psychiatric disease.