HospitalInspections.org

Based on observation, review of facility documents, and interviews with staff (EMP), it was determined the facility failed to ensure a safe setting for patients.

Findings include:

Review of facility policy "Safety Inspections," dated February 21, 2011, revealed " ... Policy: Designated network personnel will perform periodic, intermittent and special safety inspections of Albert Einstein Healthcare Network to identify actual and/or potential unsafe conditions and unsafe practices. A plan of action will be established to eliminate or reduce identified or potential unsafe conditions ... "

Observation on August 5, 2013, of the 1 Center Geriatric Psychiatric Unit's patient rooms 139, 140, 141, 143, and 144, revealed each patient's bathroom shower stall contained a hand held shower head, that was connected to a flexible shower cord. The cord measured approximately four feet in length and was approximately three feet from the ground. The shower cord could be used as a ligature device that the patient could tie around their neck.

Review of facility policy "EOC [Environment of Care] Patient Room Risk Assessment," dated 2013, revealed " ... Inspection Points ... Bathroom ... Is the shower head and water controls recessed and/or designed to prevent self harm (anti-ligature) ... "

Interview on August 5, 2013, at 11:00 AM, with EMP2 confirmed that the hand held shower cords could be used as a ligature device that a patient could tie around their neck.

Observation on August 5, 2013, of the 1 Center Geriatric Psychiatric Unit's dietary area revealed a storage closet that contained the following cleaning agent bottles: A Hepacide Quat II Virucidal Disinfectant cleaner; a 3M Sharpshooter extra strength marker remover; and PDI sanicloth AF3 Germicidal Disposable wipes.

Review of the Hepacide Quat II Virucidal Disinfectant cleaners manufacturer's instructions revealed " ... Storage & Disposal ... Do not contaminate water, food, or feed by storage ... "

Further observation of storage closet revealed two bags of Fritos, eight bags of pretzels, one bag of popcorn, and an opened pack of cigarettes, all which were stored in the same closet as the above mentioned cleaning agent bottles.

Interview on August 5, 2013, at 11:00 AM, with EMP2 confirmed the above mentioned storage closet contained both cleaning agents and food products.

Review of facility policy "Refrigerator Maintenance," dated June 3, 1999, revealed " ... III. Responsibility ... It is the Environmental Department staff's responsibility to clean the patient refrigerator on a weekly basis and record the cleaning on the sheet provided ... "

Review of facility policy "Patient Room - Daily," dated May 31, 2002, revealed "Procedure: A. Organize equipment - clean cloths, high dusting tool with head, disinfectant solution, liquid cleanser, dust mop, wet mop, wringer/bucket, dust pan, toilet brush and abrasive green hand pads, putty knife, carpet spotter (where applicable), 5-quart pail, paper towels, toilet paper, plastic liners, goggles, vinyl gloves and counter brush ... " Review of the policy did not reveal vacuuming as an identified daily task.

Observation on August 5, 2013, of the 1 South Adolescent Psychiatric Unit's patient rooms 160, 161, 162, 166, and 167, revealed each patient room was carpeted. Further observation of each patient room revealed an excessive amount of debris on the carpets to include food particles, wrappers, and other unknown particles and substances.

Interview on August 5, 2013, at 11:45 AM, with EMP2 confirmed that patient rooms 160, 161, 162, 166, and 167, contained an excessive amount of debris on the carpets to include food particles, wrappers, and other unknown particles and substances.

Interview on August 6, 2013, at 1:15 PM, with EMP1 confirmed that the facility's policy did not include vacuuming as an identified daily task.

Observation of the 2 East Eating Disorder Unit and the 2 North Affective Disorder Psychiatric Unit shared Dietary room reveled a refrigerator that contained various amounts of unidentified stains on the refrigerator's: shelving, walls, and inside door, which were of various colors and were of various sizes. Further observation of the dietary room revealed a microwave that contained various amounts of unidentified stains on the walls and inside door, which were in various colors and were of various sizes.

Interview on August 5, 2013, at 12:30 PM, with EMP2 confirmed that the refrigerator and microwave contained excessive amounts of unidentified stains.

Observation of the 2 East Eating Disorder Unit and the 2 North Affective Disorder Psychiatric Units shared interview room reveled the room was carpeted and the carpet contained an excessive amount of debris on the carpet to include food particles, wrappers, and other unknown particles and substances.

Interview on August 5, 2013, at 12:40 PM, with EMP2 confirmed the carpet contained an excessive amount of debris on the carpet to include food particles, wrappers, and other unknown particles and substances.

Observation on August 5, 2013, of the 2 Center Adolescent Psychiatric Unit's patient rooms 246 and 266, revealed a bed in each room that had a space from the side of the beds to the adjacent wall. The space between each bed contained a various amount of debris to include: food particles, food wrappers, socks, and other unknown substances.

Interview on August 5, 2013, at 1:20 PM, with EMP2 confirmed the above findings.

Review of facility policy "Medication Storage/Refrigeration," dated March 13, 2013, revealed " III. Procedures ... 4. Expired, discontinued, contaminated or excess medications shall be removed and disposed of in a safe, lawful manner ... "

Observation on August 5, 2013, of the 1 Center Geriatric Psychiatric Unit's dietary area revealed a storage cabinet that contained three opened bags of cookies and the bags of cookies did not contain a date when they would expire.

Interview on August 5, 2013, at 11:10 AM, with EMP2 confirmed that the storage cabinet contained three opened bags of cookies and the bags of cookies did not contain a date when they would expire.

Observation of the 2 East Eating Disorder Unit and the 2 North Affective Disorder shared medication room on August 5, 2013, revealed the following expired products: the medication refrigerator contained four syringes of Influenza Virus Vaccine marked expired June 2013; a storage drawer contained 30 packets of Aplicare Povidone-Iodine Ointment that were marked expired September 2012 and 10 packets of Medi Choice Lubricating Jelly marked expired January 2012.

Interview on August 5, 2013, at 12:15 PM, with EMP2 confirmed the above supplies were expired.

Observation of the 2 East Eating Disorder Unit and the 2 North Affective Disorder shared units shared clean supply room on August 5, 2013, revealed two 500 ml prefilled humidifier sterile water for inhalation marked expired June 2009.

Interview on August 5, 2013, at 12:20 PM, with EMP2 confirmed the above supplies were expired.

Observation on August 5, 2013, of the 2 East Eating Disorder Unit and the 2 North Affective Disorder units shared Dietary room refrigerator revealed a four ounce container of orange juice marked expired August 1, 2013.

Interview on August 5, 2013, at 12:30 PM, with EMP2 confirmed that the container of orange juice was expired.

Based on policy review, record review, and interview, it was determined that the facility failed to develop Master Treatment Plans (MTPs) for 6 of 10 active sample patients (3, 45, 56, 82, 98 and 117) that included individualized treatment interventions with a specific purpose and focus. Many of the interventions on the MTPs were generic, pre-printed interventions; for one patient the intervention was not linked to a problem or goal (Patient #3). Failure to clearly describe specific modalities on patients' MTPs may hamper staff's ability to provide treatment based on individual patient needs.

Findings are:

A. Policy Review

The facility policy and procedure for treatment planning, # 550-001.4, dated 1/5/12 states, "Interventions are multidisciplinary and describe the specific treatment and the frequency that will be provided."

B. Record Review

1. Patient 3: Admitted on 8/1/13 with MTP dated 8/2/13.
An identified problem stated, "Inability to function or care for his/her self as evidenced by: confused with memory impairment...", but there were no interventions linked to the identified problem.
For identified problem "Hypertension" treatment modality stated, "Ger-Med [sic] consult as indicated." This is an assessment, not an intervention.
A treatment modality stated, "Group sessions up to 12 times per week targeting group living + socialization," but was not linked to an identified problem.

2. Patient 45: Admitted on 5/2/13 with MTP update dated 5/31/13.
Pre-printed treatment modalities for the identified problem, "Mood Disturbance (depression)" stated, "Monitor medication for safety, efficacy and adverse effect" and "provide education about medication and symptom management." These were generic, without specific focus for this patient, and lacked frequency.

3. Patient 56: Admitted on 7/5/13 with MTP dated 7/8/13.
Treatment modalities for the identified problem, "Aggressive/Assaultive behavior as evidenced by...aggression towards others and property destruction" stated "Supportive psychotherapy 5 times per week targeting coping skills and managing aggression." This lacked specific focus for the patient.
For identified problem "red dye allergy" generic intervention stated, "peds [sic] consult(s) as indicated." This is an evaluation not an intervention.

4. Patient 82: Admitted 7/31/13 with MTP dated 8/3/13.
Treatment modality for the identified problem "Suicidal/self harm behaviors as evidenced by S/I (suicidal ideation) w(ith)/plan to cut wrists; depression," was a generic intervention that stated "group sessions up to 3 times per week targeting building insight; coping skills."

5. Patient 98: Admitted on 7/25/13 with MTP dated 7/26/13.
Treatment modality for the identified problem "Positive UDS (Urine Drug Screen) for cocaine" stated, "Encourage attendance in recovery programs." This is a routine staff function, not a specific intervention, with focus and frequency.
Treatment modalities for identified problem "Auditory hallucinations; Mom's voice" stated, "Monitor medication for safety, efficacy and adverse effect" and "provide education about medication and symptom management." These are routine staff functions without focus for the specific patient or frequency.

6. Patient 117: Admitted 7/26/13 with MTP dated 7/27/13.
Treatment modalities for the identified problem "Auditory hallucinations and delusions" stated, "Monitor medication for safety, efficacy and adverse effect" and "provide education about medication and symptom management." These are routine staff functions, not specific interventions with focus and frequency for this patient.
For the identified problem "Diabetes" the interventions stated, "Diagnostic studies as indicated" and "Monitor symptoms daily or more frequently as indicated." The first is an evaluation not an intervention; the second is a routine staff function without specificity for this patient.

C. Interview:

1. In an interview on 8/6/13 at 1:00 p.m., the Medical Director stated that the interventions on the treatment plans cited above were non-specific, not individualized, and did not address specific patient needs.

2. In an interview on 8/6/13 at 2:00 p.m. the Director of Nursing (DON) stated that many treatment interventions were generic in nature.

Based on record review and interview, the Medical Director failed to ensure that treatment plans for 6 of 10 active sample patients (3, 45, 56, 82, 98 and 117) were individualized. The treatment interventions were non-specific and similar for all patients, regardless of the patient's problems. Failure to clearly describe specific modalities on patients' MTPs may hamper staff's ability to provide treatment based on individual patient needs.



Findings are:

A. Record review:

1. Patient 3: Admitted on 8/1/13 with MTP dated 8/2/13.
An identified problem stated, "Inability to function or care for his/her self as evidenced by: confused with memory impairment...", but there were no interventions linked to the identified problem.
For identified problem "Hypertension" treatment modality stated, "Ger-Med [sic] consult as indicated." This is an assessment, not an intervention.
A treatment modality stated, "Group sessions up to 12 times per week targeting group living + socialization," but was not linked to an identified problem.

2. Patient 45: Admitted on 5/2/13 with MTP update dated 5/31/13.
Pre-printed treatment modalities for the identified problem, "Mood Disturbance (depression)" stated, "Monitor medication for safety, efficacy and adverse effect" and "provide education about medication and symptom management." These were generic, without specific focus for this patient, and lacked frequency.

3. Patient 56: Admitted on 7/5/13 with MTP dated 7/8/13.
Treatment modalities for the identified problem "Aggressive/Assaultive behavior as evidenced by...aggression towards others and property destruction" stated "Supportive psychotherapy 5 times per week targeting coping skills and managing aggression." This lacked specific focus for the patient.
For identified problem "red dye allergy" generic intervention stated, "peds [sic] consult(s) as indicated." This is an evaluation not an intervention.

4. Patient 82: Admitted 7/31/13 with MTP dated 8/3/13.
Treatment modality for the identified problem "Suicidal/self harm behaviors as evidenced by S/I (suicidal ideation) w(ith)/plan to cut wrists; depression," was a generic intervention that stated "group sessions up to 3 times per week targeting building insight; coping skills."

5. Patient 98: Admitted on 7/25/13 with MTP dated 7/26/13.
Treatment modality for the identified problem "Positive UDS (Urine Drug Screen) for cocaine" stated, "Encourage attendance in recovery programs." This is a routine staff function, not a specific intervention, with focus and frequency.
Treatment modalities for identified problem "Auditory hallucinations; Mom's voice" stated, "Monitor medication for safety, efficacy and adverse effect" and "provide education about medication and symptom management." These are routine staff functions without focus for the specific patient or frequency.

6. Patient 117: Admitted 7/26/13 with MTP dated 7/27/13.
Treatment modalities for the identified problem "Auditory hallucinations and delusions" stated, "Monitor medication for safety, efficacy and adverse effect" and "provide education about medication and symptom management." These are routine staff functions, not specific interventions with focus and frequency for this patient.
For the identified problem "Diabetes" the interventions stated, "Diagnostic studies as indicated" and "Monitor symptoms daily or more frequently as indicated." The first is an evaluation not an intervention; the second is a routine staff function without specificity for this patient.

B. Interview:

In an interview on 8/6/13 at 1 p.m., the Medical Director stated that the interventions on the treatment plans cited above were non-specific, not individualized, and did not address specific patient needs.

Based on record review and interview, the DON failed to ensure that treatment plan nursing interventions were specific and individualized in the MTPs for 5 of 10 active sample patients (3, 45, 56, 98 and 117). Failure to clearly describe specific modalities on patients' MTPs may hamper staff's ability to provide treatment based on individual patient needs.

Findings include:

A. Record review:

1. Patient 3: Admitted on 8/1/13 with MTP dated 8/2/13.
An identified problem stated, "Inability to function or care for his/her self as evidenced by: confused with memory impairment...", but there were no interventions linked to the identified problem.
For identified problem "Hypertension" treatment modality stated, "Ger-Med [sic] consult as indicated." This is an assessment, not an intervention.
A treatment modality stated, "Group sessions up to 12 times per week targeting group living + socialization," but was not linked to an identified problem.

2. Patient 45: Admitted on 5/2/13 with MTP update dated 5/31/13.
Pre-printed treatment modalities for the identified problem, "Mood Disturbance (depression)" stated, "Monitor medication for safety, efficacy and adverse effect" and "provide education about medication and symptom management." These were generic nursing activities, without specific focus for this patient, and lacked frequency.

3. Patient 56: Admitted on 7/5/13 with MTP dated 7/8/13.
For identified problem "red dye allergy" generic nursing intervention stated, "peds [sic] consult(s) as indicated." This is a medical discipline evaluation not a nursing intervention.

4. Patient 98: Admitted on 7/25/13 with MTP dated 7/26/13.
Treatment modality for the identified problem "Positive UDS (Urine Drug Screen) for cocaine" stated, "Encourage attendance in recovery programs." This is a routine nursing staff function, not a specific intervention, with focus and frequency.
Treatment modalities for identified problem "Auditory hallucinations; Mom's voice" stated, "Monitor medication for safety, efficacy and adverse effect" and "provide education about medication and symptom management." These are routine nursing staff functions without focus for the specific patient or frequency.

5. Patient 117: Admitted 7/26/13 with MTP dated 7/27/13.
Treatment modalities for the identified problem "Auditory hallucinations and delusions" stated, "Monitor medication for safety, efficacy and adverse effect" and "provide education about medication and symptom management." These are routine nursing staff functions, not specific interventions with focus and frequency for this patient.
For the identified problem "Diabetes" the interventions stated, "Diagnostic studies as indicated" and "Monitor symptoms daily or more frequently as indicated." The first is an evaluation not an intervention; the second is a routine nursing staff function without specificity for the patient.

B. Interview:

In an interview on 8/6/13 at 2:00 p.m. the Director of Nursing stated that many treatment interventions were generic in nature.