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Based on staff interviews, policy and procedure review, and review of the facility's general consent form, the facility failed to inform outpatients and emergency department patients of their rights.

Findings:

During an interview with a registration clerk on Thursday December 30, 2010, the clerk stated that all patients, whether they were inpatients or outpatients, signed the same "General Consent To Hospital Services & Care" when registered. She said every patient was also provided the privacy policy but acknowledged that outpatients and emergency room patients were not informed of their rights unless that patient became an inpatient. The Director of Quality Improvement Patient Safety was present during the interview.

On the same day, the facility's "General Consent To Hospital Services & Care" was reviewed. The two-paged consent read in part, "I acknowledge that I received a copy of the Patients Bill of Rights, (name of facility) Notice of Privacy Practices, written information regarding advance directives and the Important Message from Medicare (if covered by Medicare)." The facility's "Summary Information about the (name of facility) Notice of Privacy Practices" was also reviewed. Although the notice included information entitled "Your General Rights," which listed patients' rights regarding medical information the facility maintained about the patient, it did not include a complete list of patients rights and responsibilities.

The facility's policy titled "Patient Rights and Responsibilities" was reviewed on December 29, 2010. The policy read in part, "Special Instructions: 1. The Patient's Bill of Rights will be incorporated as a part of this policy and shared with all registered patients by the distribution of Patient Rights and Responsibilities brochure."

On December 30, 2010 the Director of Quality Improvement & Patient Safety acknowledged the facility's "Patient Rights and Responsibility" policy and the facility's "General Consent To Hospital Services and Care" both indicated all registered patients were to be provided their patients rights. She indicated each outpatient area and each emergency department room had a Patient Rights poster hanging on the wall. The Director acknowledged outpatient and emergency department patients were not being provided or informed of their rights unless they were admitted as inpatients.

Based on staff interviews and clinical record review the facility failed to provide care in a safe setting.

Findings include:

On December 30, 2010, the surveyor interviewed the registration clerk who registered Patient #2 on 10/16/10. The clerk stated she was working in the Adult Outpatient registration area at the time Patient #2 entered the facility being carried by his mother. The clerk stated that although that registration area was not intended for pediatric registrations, she did register the patient at that time. She was the only clerk registering patients in that area on 10/16/10, and therefore could not accompany Patient #2 and family to the appropriate floor. She called another staff member to accompany Patient #2 and family to the Pediatric Treatment Center. The clerk could not recall with certainty whether Patient #2 and family were provided a wheelchair and stated that a walk from the Adult Outpatient registration area to the Pediatric Treatment Center was "a long way."

The Director of Quality and Patient Safety acknowledged on December 30, 2010 that Patient #2 was carried to the Pediatric floor (to the Pediatric Treatment Center) by the adult that accompanied the patient, no wheelchair or stretcher was provided from the Adult Outpatient registration area.

On Wednesday December 29, 2010 the Pediatric Nurse (Nurse #2) who first encountered Patient #2 and family on the pediatric floor on Saturday October 16, 2010 was interviewed. Nurse #2 said she saw Patient #2 being carried down the hallway by an adult so she assisted them to a room and took responsibility for his care. The nurse said Patient #2 looked 'puny'.

Patient #2's clinical record was reviewed on 12/30/10. Nurse #2 documented the patient's appearance as "ill appearing and lethargic." The nurse also noted an increased respiratory effort and mottled (blotchy) skin. Bloodwork results revealed Patient #2's blood glucose = 691 (normal: 74-106) and a CO2 (Bicarb) = 5 (normal: 20-31). The patient was transferred to a facility with a higher level of care approximately 5 and 1/2 hours after arriving at the facility.