HospitalInspections.org

Based on record review and interview the hospital failed to ensure the rights of psychiatric patients were included in the "Patient Rights" provided to all patients upon admit to the hospital for 10 of 10 psychiatric medical records. This has the potential to effect all patients admitted with a psychiatric diagnosis to the hospital. Findings:

Review of the "Patient Rights Booklet" submitted by the hospital as the one currently being provided to all patients admitted to the hospital including those on the psychiatric in-patient unit and the MHERE unit (Mental Health Emergency Room Extension), revealed no documented evidence mental health rights were included.

Review of the medical records of Patient #1, #2, #3, #4, #5, #6, #7, #8, #9 and #10 revealed no documented evidence mental rights were provided to the patients with a psychiatric diagnosis.

In a face to face interview on 06/24/11 at 9:30am S8, Senior Director of Quality Assurance and Performance Improvement verified the mental health rights were not included in the brochure provided to patients informing them of their patient rights.

Based on record review and interview the hospital failed to inform a patient of his transfer to a acute care psychiatric hospital as evidenced by failing to obtain the patient's signature on the transfer consent form for 1 of 10 sampled patients with psychiatric diagnoses transferred to higher levels of care. Findings:

Review of the medical record for Patient #3 revealed a 69 year old man admitted to the Emergency Department on 09/10/10 at 1301 (1:01pm) with the diagnoses of delusions and psychosis. Patient #3 was PEC'd (Physician's Emergency Certificate) and admitted to the MHERE (Mental Health Emergency Room Extension) for close visual observation and placement in an acute care setting.

Review of the "Consent to Transfer" dated 09/11/11 at 0245 (2:45am) revealed in the space provided for the signature of the patient/relative or guardian documented with an X "Pt. (Patient) PEC'd, Psychotic. Further review revealed the patient's name (Patient #3) was printed , the date 09/11/10, time 0245 (2:45am) and the signature of two staff nurses. The section indicating the reason for patient/relative or guardian not signing the form, the signature, date and time (of the person who determined the patient was not able to sign the consent) was left blank.

Review of the Physician's Notes (Emergency Department) for Patient #3 revealed the MD S6 assessed Patient #3 on 09/10/10 at 2000 (8:00pm). Further review revealed no documented evidence Patient #3 was re-assessed by Emergency Room MD S6 or a psychiatrist.

Review of the Nursing Notes for Patient #3 revealed he was assessed at 09/10/10 at 1910 (7:10pm) as "cooperative, suspicious of neighbor that allegedly has flown helicopters > (greater than) 4 times, hovering around his house, shining floodlights into his bedroom at night, spraying bug poison around his house, and just flying around to generally harass him. Speech is normal, pressured, Affect is appropriate. Subjective: Patient's mood is elevated. Delusions are persecutory directed toward neighbor with trucking business next door". Further review revealed no documented evidence of any nursing entries concerning the patient's condition/behavior on 09/11/10 at 0245 (2:45am) at the time RNs S4 and S5 documented they both witnessed Patient #3's inability to sign the consent for transfer.

In a face to face interview on 06/24/11 at 8:00am RN S4 indicated she was working on the night shift in the Emergency Department when Patient #3 was transferred out. S4 indicated Patient #3 was on the MHERE unit and she had not actually observed or assessed his behavior. RN4 indicated when only one nurse is assigned to the MHERE unit, the paperwork for transfer of a patient to another facility is sent to the ER and a nurse reviews and signs her name to the transfer form if the patient is not able to sign.

In a face to face interview on 06/24/11 at 8:30am RN5 verified she had signed the transfer consent form for Patient #3 which indicated he was not able to sign for himself because he had been PEC'd and was psychotic. S5 indicated she herself had not observed Patient #3's behavior, but assumed Patient #3 was incapable of signing due to the PEC and his diagnosis.