HospitalInspections.org

Based on review of facility documents, medical record (MR), and staff interviews (EMP), it was determined the facility failed to follow their established Patient's Bill of Rights, by failing to ensure care was rendered in a safe setting, and by failing to follow adopted policies related to constant observation of psychiatric patients for one of one patients. (PT1)

Findings include:

Review of Mount Nittany Medical Center's policy entitled "Patient Rights", dated May 21, 2010, revealed "Policy: In conjunction with regulatory standards, it is the policy of Mount Nittany Medical Center to ensure that patients are aware of their rights and responsibilities, including the right to voice concerns without recrimination. The brochure "A Statement of the Patient's Rights and Responsibilities" ... is the primary written vehicle for informing patients about these rights ... ."

Review of the Brochure entitled "Patient Rights and Responsibilities", revealed "... You have the right to receive care in a safe setting ... ."

Review of Mount Nittany Medical Center's (MNMC) Emergency Department policy and procedure related to "Emergency Treatment of Mental Health Disorders: Emergency Psychiatric Transfers", dated April 2010, revealed "Policy: 1. Patients, who require inpatient psychiatric treatment and are not candidates for admission to the Psychiatric Unit at MNMC, are to be transferred to an appropriate facility. This also applies whenever the patient meets the admission guidelines to the Psychiatric Unit at MNMC and there is no bed space ... 3. While awaiting transfer to another psychiatry unit, the patient remains under the direct care of the Emergency Department Physician. The patient must be kept under constant observation while in the department ... ."

Review of Mount Nittany Medical Center's Emergency Department policy and procedure entitled "Emergency Treatment of Mental Health Disorders: Evaluation An Outpatient Referral", dated April 2010, revealed "... Patients with mental health disorders will be examined in the psychiatry treatment areas (Rooms 10/10A) unless associated medical conditions require cardiovascular monitoring or intravenous therapy, in which case the patient will be assigned to a critical care bay bed ... 7. Medically cleared Mental Health patients, who in any way may be considered a danger to self or others, are to be placed in the Seclusion Room (Room 14) ...."

1) Review of the patient's (PT1) medical record (MR1) revealed documentation that the patient presented to the Emergency Department, following complaints of depression and suicidal ideations, for medical clearance for an inpatient psychiatric admission. Documentation in the medical record indicated that the patient was placed in close observation. Continued review of the patient's medical record revealed that the patient had occupied Room 14A (Bereavement Room) and Room 14 (Seclusion Room) during the Emergency Department visit.

2) Interview with EMP3 on November 8, 2010, at 10:15 AM, revealed "... [The patient] proceeded to let me know that if we would have taken [the patient] seriously [regarding suicidal ideations], all the opportunities [the patient] would have had. Like the tray in the room with china, walked to the TV room to watch TV, identified the cords that would have been available ... I told [the Clinical Supervisor] not take [the patient] back to watch TV... [The patient] was in the seclusion room ... There was an oxygen tank in the room on the litter ... The tray had real dishes ... An overbed table was there with a chair. [The patient] was eating breakfast on it. [The patient] said they offered ...the opportunity to watch television. That was in [the patient's] observations if [the patient] was suicidal, these were ways to commit suicide ... ."

3) An interview with EMP5 on November 8, 2010, at 12:25 PM, revealed "[The patient] was in room 14, the mental health room. Maybe in the 14A lounge, before I came in. Usually patients are put on the litter in 14. [The patient] was probably in 14A because a TV was in there and last time [the patient] complained about being bored. [The patient] made the comment about the bags/cords. I think they may have told me that [the patient] had a comment [the patient] wanted to hurt [themselves] ... ."

4) An interview with EMP6 on November 8, 2010, revealed "... We got lax with [the patient] ... [The patient] comes in so frequently, we let [the patient] watch TV if [the patient] wants to." EMP6 continued by stating that rooms 9, 10, 11, and 12 are normally used for close observation, not the TV room. EMP 6 also confirmed that Room 14A does contain cords and a chair, and that patients would be left unattended in this room.

5) During a tour of the Emergency Department on November 8, 2010, it was noted that Room 14A, was adjacent to the Seclusion Room. The room contained two small couches, a television, a phone, a lamp, and a cabinet with a computer screen inside the shelf. The room also contained a small wood child's chair. It was also noted that the room does not have a camera and is not visible from the nurse's station.

6) An interview with EMP9 via telephone on November 10, 2010, at 2:45 PM, revealed " I remember [the patient] in 14, when [the patient] got there. [The patient] asked me to move [the patient] to 14A because of the TV ... The [the patient] said about the phone cord, and 14A isn't safe, and someone could get hurt with the cord or trash bag. I automatically said I'd put [the patient] back in 14 immediately. [The patient] did threaten [they] would use the phone cord to hurt [themselves] ... [The patient] was not suicidal that night. [The patient] felt fine when [the patient] came in ... I was the one who moved [the patient] back in 14, if [the patient] was going to make remarks like that ... The seclusion room (14) doors were open. [The patient] didn't need seclusion. I put [the patient] back there because that's the room we usually for [this patient]. We usually make sure someone is there at all times ... ."

7) An interview with EMP10 via telephone on November 12, 2010, at 9:30 AM, revealed
"... Technically, [the patient] shouldn't have been in a room with a TV. For [this patient], I don't feel uncomfortable, putting [the patient] in the room with a TV. 14A is the grieving room. It has a couch, TV, and phone ... [The patient] wanted to go back to the TV room ... [The patient] likes the TV and the phone ... 14A is not a safe room. It has a TV, outlets, lights, and objects that could be used a weapon. The oxygen cylinder under the bed shouldn't occur ... It's definitely not safe ... ."

Based on review of facility documents and medical record (MR), and staff interviews (EMP), it was determined the facility failed to adopt policies which ensured that an area in the Emergency Department was utilized only for which it was designed, and failed to adopt policies which defined procedure requirements and expectations related to psychiatric patients requiring close/constant observation.

Findings include:

Review of Mount Nittany Medical Center's Emergency Department policy and procedure entitled "Emergency Treatment of Mental Health Disorders: Evaluation An Outpatient Referral", dated April 2010, revealed "... Patients with mental health disorders will be examined in the psychiatry treatment areas (Rooms 10/10A) unless associated medical conditions require cardiovascular monitoring or intravenous therapy, in which case the patient will be assigned to a critical care bay bed ... 7. Medically cleared Mental Health patients , who in any way may be considered a danger to self or others, are to be placed in the Seclusion Room (Room 14) ...."

1) Interview with EMP6 on November 8, 2010, revealed that Rooms 10/10A in the above policy were re-numbered, and are now Rooms 14/14A. EMP 6 also stated that Room 14A is a bereavement room. EMP6 stated that Room 14A has been used for psychiatric patients as an overflow psychiatric room to hold patients until a room is available, and that the room is normally used for grieving families or for patients to have sutures removed. EMP6 also stated that the room has probably been used for psychiatric patients three to four times in the last six months.

On November 8, 2010, review of MR1, confirmed that the patient had occupied Room 14A during the Emergency Department visit.

Interview with EMP5 on November 8,2010, at 12:25 PM, revealed "[The patient] was in room 14, the mental health room. Maybe in the 14A lounge, before I came in ... [The patient] was probably in 14A because a TV was in there and the last time [the patient] complained about being bored ... ."

Interview via telephone with EMP7, on November 9, 2010, at 8:08 AM, revealed "... I went in to see [the patient] ... I think [the patient] was was in 14A at that point ... ."

Interview via telephone with EMP9, on November 10, 2010, at 2:45 PM, revealed "I remember [the patient] in 14, when [the patient] got there. [The patient] asked me to move ... to 14A because of the the TV ... ." When asked how often Room 14A is used for patients, EMP9 stated a handful of times, probably a dozen.

Interview via telephone with EMP10, on November 12, 2010, at 9:30 AM, revealed "... 14A is the grieving room. It has a couch, TV, and phone. We will sometimes put people in there ... ."

2) An interview with EMP5, on November 8, 2010, at 12:25 PM, revealed [regarding close observation] "... the patient would be in the secure room, with the camera on ... ."

An interview with EMP6, on November 8, 2010, revealed that close observation means on camera or in the front where observation an occur. EMP6 also stated that Rooms 9, 10, 11, and 12 are normally used for close observation, not the TV (Bereavement) room (Room 14A).

Continued interview with EMP6, on November 8, 2010, revealed that the facility does not have a policy defining procedure requirements and expectations related to patients who require close/constant observation.