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Based on interview and record review, the facility failed to protect one patient from physical and verbal abuse when one registered nurse (RN 1) put one hand forcefully on the throat of Resident A while also verbally threatening her.

Findings:

The clinical record for Resident A was reviewed on August 25, 2010 at 8:30 AM. The Emergency Nursing Record dated August 23, 2010 indicated Resident A was triaged at the facility's Emergency Department (ED) at 2:05 PM. The Emergency Nursing Record, written by Registered Nurse 2 (RN 2), indicated Resident A was complaining of pain to the right side of her neck, but there were no discolorations anywhere on the neck and no evidence of trauma.

The Supplemental Nurses Notes dated August 23, 2010 indicated that RN 3 was providing care to Resident A at 7:30 PM. The notes written by RN 3, read as she was receiving shift report, "(RN 1) went into room to patient's bedside, patient was yelling she needed to get out of bed to go to the bathroom." RN 3 wrote Resident A was holding onto the bedside curtain for assistance to get out of bed. RN 3 wrote RN 1 denied her request, and stated to Resident A, "Go ahead and get up out of bed and fall down, he did not care." RN 3 wrote RN 1 then tried to reposition Resident A back up on the gurney, but PT A resisted this. RN 3 then wrote "I was nearer the doorway headed into the room and witnessed (RN 1) place his right hand around the neck of the patient's throat and forcefully push her back up the gurney." RN 3 wrote RN 1 "Looked visibly angry" and Resident A "Was screaming." RN 3 wrote as she was approaching the bedside, "(Resident A) saw me and said, " Help me, he is trying to kill me. " The patient was visibly shaking and screaming for me to get him away from her, because he said he was going to kill her and had choked her. There was a visible red mark to the left side of neck."

A statement written by Emergency Department Technician 1 (ET 1), dated August 24, 2010 was reviewed. It read she "heard (RN 1) yelling at (Resident A)...'I don't care what you do, go ahead and fall, I don't care'. The statement read after RN 3 entered Resident A's room, Resident A was yelling, " He tried to kill me, get him out of here, he choked me...' She was holding the left side of her neck as she was explaining she had been choked. (RN 3) and I looked at her neck and saw a red mark to the left side."

During an interview with RN 2 on August 31, 2010 at 3 PM, she stated she had provided care to Resident A for several hours on August 23, 2010 in the facility's ED. RN 2 stated at approximately 7:30 PM, she saw RN 1 walk into the exam room where Resident A was lying on a gurney. RN 2 stated she heard the conversation between the two get louder. RN 2 stated she couldn't see RN 1 do anything to Resident A based upon where RN 2 was sitting. RN 2 stated later she saw Resident A was "hysterical" and was saying "something about him 'trying to kill me'". RN 2 stated she and RN 3 examined PT A, and now both saw a "red spot, maybe the size of a 50-cent piece" on the left side of her neck.

During an interview with RN 3 on September 7, 2010 at 9:30 PM, she stated she observed the event with RN 1 and Resident A. RN 3 stated on August 23, 2010 at approximately 7:30 PM, she was standing in the doorway to the exam room where Resident A and RN 1 were located. RN 3 stated, "I don't think he saw me or knew I was there. I saw him put his hand on her [Resident A] throat." RN 3 stated later, after RN 1 had been removed from duty, and as she was trying to calm Resident A down, she noticed a mark on the left side of her neck. RN 3 stated PT A was "shaking violently." RN 3 said Resident A told her that RN 1 stated, "I'll kill you bitch if you get out of bed. " RN 3 stated Resident A repeated this statement, over and over, "For a couple of hours."