HospitalInspections.org

Based on interviews and review of medical records and facility documents it was determined that the Governing Body failed to provide appropriate medical staff to meet the needs of patients with psychiatric needs. This practice have cause harm to patients and prolong the hospital stay.

Findings Include:

The facility is a designated Level 2 trauma center and does treat patients who have attempted suicide, multiple traumas, and other patients with psychiatric needs. Psychiatric services are essential to the needs of these patients

1. Patient #1 was admitted to the trauma services on 6/22/10 for a self inflicted gunshot wound. Physician progress note dated 6/23/10 indicated the patient had a positive drug screen and had a history of depression. On 6/26/10 a Certificate of Professional Involuntary Examination was completed by a psychologist. On 6/26/10 the psychologist recommends treatment for depression and Effexor (an antidepressant). On 6/29/10 the psychologist documents that the patient's depression will need to be treated during the hospitalization. There was no documented follow through by the attending/ordering physicians or acknowledgement of the psychologist's recommendation for treatment and medication.

Interview of the Neuro Step-Down Unit Manager on 6/30/10 at approximately 1:30 p.m. revealed no knowledge if the attending/ordering physician had reviewed the progress notes of the psychologist to be aware of the findings and recommendations.

2. Interview with the Clinical Director on 6/30/10 at approximately 1:30 p.m. revealed the hospital does not offer psychiatric services. The interview indicated the hospital does not have a psychiatric unit and therefore does not have a psychiatrist on staff.

3. Interview with the Director of Clinical Services on 7/1/10 at 10:30 a.m. revealed that even though Psychiatry is listed on the Inventory of Services offered and on the facility's license, it is not a service that is offered. The Director of Clinical Services indicated if a psychiatric consult is ordered than a psychologist will perform the consult.

Review of the Medical Staff Bylaws and Rules and Regulations did not show evidence of all of the medical staff being aware of a psychologist providing the psychiatric consult and a physician being responsible for the recommendations..

4. Review of facility's License and Inventory of Services, no date, revealed Psychiatric Services are offered twenty hours seven days a week directly or indirectly through an agreement with one or more physician..

The interview and review of documentation revealed the facility did not provided services within its scope of services offered to meet the psychiatric needs of patients.

Based on interviews and review of medical record and facility documentation it was determined that the Governing body failed to ensure the attending physician was responsible for the care of each patient with respect to psychiatric problems that were present on admission and was not specifically within the scope of practice of a psychologist for 1 (#1) of 6 records reviewed. This practice does not ensure patients' psychiatric needs are met and may prolonged the hospital stay.

Findings Include:

1. Patient #1 was admitted to the trauma services on 6/22/10 for a self inflicted gunshot wound. Physician progress note dated 6/23/10 indicated the patient had a positive drug screen and had a history of depression. On 6/26/10 a Certificate of Professional Involuntary Examination was completed by a psychologist. On 6/26/10 the psychologist recommends treatment for depression and Effexor (an antidepressant). On 6/29/10 the psychologist documents that the patient's depression will need to be treated during the hospitalization. There was no documented follow through by the attending/ordering physicians or acknowledgement of the psychologist's recommendation for needed treatment and medication in a patient who attempted suicide.

Interview of the Neuro Step-Down Unit Manager on 6/30/10 at approximately 1:30 p.m. revealed no knowledge if the attending/ordering physician had reviewed the progress notes of the psychologist to be aware of the findings and recommendations.

2. Review of the facility's Privilege Request Form
revealed the core privileges for Clinical Psychology were Consultation, differential Diagnosis, and treatment planning for all disorders as defined by the Diagnostic and Statistical manual or Mental Disorders IV, and Administration and Interpretation of psychological tests.

Based on record reviews and interviews the facility failed to ensure the nursing staff developed and kept current a care plan for 1 (#1) of 6 records related to the care of patients with psychiatric needs and pain management. This practice does not ensure patient goals are met.

Findings Include:

1. Patient #1 was admitted on 6/22/10 for a self inflicted gunshot wound to the face, depression and substance abuse. Review of the nursing care plan did not address the depression or potential identification from drug withdrawals. Psychologist progress note dated 6/26/10 indicated the depression needed to be treated with an antidepressant.

The Medication Administration Record dated 6/23/10 to 6/30/10 revealed pain and anxiety medications (Hydromorphone and Ativan) were administered. The medications for pain and anxiety are documented to be given throughout the day without a nursing care plan for assessment planning, intervening, and evaluating the patient's need and response to pain and antianxiety medication, and the psychiatric needs.