HospitalInspections.org

Based on record review and staff interview, the hospital failed to be in compliance with State of Vermont Statute Title 18, Chapter 42: Bill of Rights for Hospital Patients for 1 applicable patient. (Patient # 4). Findings include:

1. Per State Statute 1852. Patients' Bill of Rights for Hospital Patients: "(1) The patient has the right to considerate and respectful care at all times and under all circumstances with recognition of his or her personal dignity."

Per record review, Patient #4, age 81 was admitted to the CAH on 3/8/14 with Pneumonia and Congestive Heart Failure. The patient required close monitoring due to his/her fragile respiratory status requiring breathing treatments and intravenous antibiotics. During the night shift for 3/11/14, Patient #4 was assigned Nurse #1. However during the course of the night Patient #4 became upset with Nurse #1 and per nursing progress note states to Nurse #1 " I told you that I did not want you as my nurse. " Despite being told by Patient #4 s/he did not want Nurse #1 providing care and without appreciation of Patient #4 ' s right to considerate and respectful care, at 02:06 on 3/11/14 the Nurse #1 returns to Patient #4 ' s room and describes the patient " ...very hostile ...refused care ...demanded I leave after vital signs " . Eventually there is communication with the nurse manager and Nurse #1 and the patient assignment was changed, eliminating Nurse #1 from being responsible for Patient #4 ' s care needs.

Per interview with the Nurse Surveyor on 3/12/14 at 2:00 PM, Patient #4 confirmed s/he refused to have Nurse #1 on 3/11/14 provide nursing care and was refusing to express to CAH staff his/her specific concerns related to the events on the night of 3/11/14.

Per interview on 3/12/14 at 1:00 PM the Medical Surgical Nurse Manager stated s/he had not made an attempt to visit with Patient #4 to gather information from the patient regarding the circumstances during the night of 3/11/14.

Based on record review and confirmed through staff interview the CAH's Patient Visitation policies did not identify the clinical rationale for restricting or limiting visitors in each separate clinical unit and did not address how CAH staff would be trained to assure appropriate implementation of the policies and procedures in an effort to avoid unnecessary restricting/limiting access of visitors to patients. Findings include:

Per review of the CAH policy titled Patient Visitation Rights, dated 12/2013, 'In accordance with Federal rules, it is the policy of Porter Hospital to ensure that each patient enjoy full and equal visitation rights consistent with their preference. The visitation rights are subject to clinically necessary restrictions and limitations...Procedures...4. the right to receive visitors is subject to the restrictions contained in the Visitor Policy with respect to type of patient, regular visiting hours and number of visitors per patient.' Per review of the Visitor policy, dated 02/2013: Medical-Surgical / Special Care: A. Regular hours are 10:00 AM to 8:00 PM. B. No more than two visitors per patient unless deemed appropriate. C. Children under twelve are discouraged from visiting; Pediatrics: Long visits and too many visitors are discouraged. One parent may remain with the patient as much as desired; Obstetrics: Visiting hours are from 10:00 AM to 8:00 PM. Family may also visit at other times at the discretion of the nursing staff. Children under the age of 15 (unless a sibling of the new baby) are not allowed to visit; and Emergency Department: Visiting in the Emergency Department will be restricted to one person per patient in the treatment area, unless otherwise directed by E.R. Staff or Physician. Although the policy identifies some restrictions/limitations in each of the respective patient care units, including the prohibition of visitation by children under the age of 12 in the Medical-Surgical unit and under the age of 15 in the Obstetrics unit it does not clearly identify any clinical rationale for those restrictions/limitations. In addition the CAH policy does not address how staff, who are responsible for the implementation of the policy in each of the respective units, including the PACU (Post Anesthesia Care Unit), will be trained to assure consistent appropriate implementation of the policy, to reduce the incidence of unnecessarily restricting or limiting access of visitors to patients.

The Chief Nursing Officer confirmed, during interview on the afternoon of 2/26/14, that the policies did not included staff training and clinical rationale for restrictions/limitations of visitation privileges.