HospitalInspections.org

07814

Based on record review and interview, the facility failed to develop Master Treatment Plans that included individualized physician interventions for 8 of 8 active sample patients (A8, A12, A14, A15, A17, A19, A22 and A23) and individualized nursing interventions for 7 of 8 active sample patients (A8, A12, A14, A15, A19, A22 and A23). Instead, most of the interventions were routine, generic discipline functions inappropriately listed as individualized interventions. This deficiency results in a lack of guidance for staff in providing individualized treatment with consistency of approach to each patient's problem.

Findings include:

A. Record Review

1. Facility policy, titled "Treatment Planning", updated 10/7/11, policy #903, failed to include detailed expectations regarding the quality of interventions to be used in developing the Master Treatment Plans. Instead, the policy stated "The nurse will list at least two main problems, interventions and measurable goals" --- "The nurse will list who is responsible for overseeing the particular intervention." There was no mention of interventions being specifically related to the patient's problems and needs.

2. The following generic physician interventions in the Master Treatment plan (MTP) were:

(A) "Physician will complete a psychiatric evaluation within 24 hours and prescribe medications or antidepressants or mood stabilizers as indicated." What was described was the only variant.

(B) "ARNP [Advance Registered Nurse Practitioner]/physician will complete a history and physical within 24 hours to address medical concerns,"
These physician interventions were found in the Master Treatment Plans for: Patient A8 (MTP dated 11/14/11), Patient A12 (MTP dated 11/14/11), Patient A14 (MTP dated 11/14/11), Patient A15 (MTP dated 11/13/11), Patient A17 (MTP dated 11/10/11), Patient A19 (MTP dated 11/14/11), Patient A22 (MTP dated 11/14/11), and Patient A23 (MTP dated 11/14/11).

3. The following generic nursing intervention in the MTP for 7 of 8 active sample Patient A8 (MTP dated 11/14/11), Patient A12 (MTP dated11/14/11),Patient A14 (MTP dated11/14/11), Patient A15 (MTP dated 11/13/11), Patient A19 (MTP dated 11/14/11), Patient A22 (MTP dated 11/14/11), and Patient A23 (MTP dated 11/14/11) was- "Nursing staff will administer prescribed modifications and evaluate 2 times a day for adverse medication side effects x7 days."

Both the physician and nursing interventions were examples of routine functions carried out for all patients regardless of their needs.

B. Interviews

1.In an interview on 11/17/11 at 11:30a.m., the generic physician interventions on the Master Treatment Plans was discussed with the Medical Director. He stated, "I guess we have more work to do."

2. In an interview on 11/17/11 at 1:30p.m., the generic nursing interventions on the Master Treatment Plans were discussed with the Nursing Director. She stated, "We wanted to make sure we addressed all the things we were doing for the patient, but I see what you mean."

07814

Based on record review and interview, the Medical Director failed to monitor the quality of the physician interventions found on the Master Treatment Plans. Specifically the Medical Director failed to ensure that all the interventions were individualized and related to each patient's specific problems for 8 of 8 active sample patients (A8, A12, A14, A15, A17, A19, A22 and A23). Instead, most of the interventions were routine, generic discipline functions inappropriately listed as individualized interventions. This deficiency results in a lack of guidance for staff in providing individualized treatment with consistency of approach to each patient's problem. (Refer to B122)

Based on record review and interview, the Nursing Director failed to monitor the quality and appropriateness of the nursing interventions found on the Master Treatment Plans of 7 of 8 active sample patients (A8, A12, A14, A15, A19, A22 and A23). Instead, most of the interventions were routine, generic discipline functions inappropriately listed as individualized interventions. This deficiency results in a lack of guidance for staff in providing individualized treatment with consistency of approach to each patient's problem.

A. Record Review

1. Facility policy, titled "Treatment Planning", updated 10/7/11, policy #903, failed to include quality and expectations of interventions to be used in Master Treatment Plans. The policy stated "The nurse will list at least two main problems, interventions and measurable goals" --- "The nurse will list who is responsible for overseeing the particular intervention." There was no mention of interventions being specifically related to a Patient's problems and needs.

2. The following generic nursing intervention in the MTP for 7 of 8 active sample Patient A8 (MTP dated 11/14/11), Patient A12 (MTP dated 11/14/11),Patient A14 (MTP dated11/14/11), Patient A15 (MTP dated 11/13/11), Patient A19 (MTP dated 11/14/11), Patient A22 (MTP dated 11/14/11), and Patient A23 (MTP dated 11/14/11) was- "Nursing staff will administer prescribed modifications and evaluate 2 times a day for adverse medication side effects x7 days."

3. In an interview on 11/17/11 at 1:30p.m., the generic nursing interventions on the Master Treatment Plans were discussed with the Nursing Director. She stated, "We wanted to make sure we addressed all the things we were doing for the patient but I see what you mean."