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Based on record review and interview, it was determined the facility failed to follow the facility policy for obtaining consent for medical treatment for two (2) of five (5) patients (patients #1 and #3) who presented to the Emergency Room.

The findings include:

A review of the medical record for patient #1 was conducted on June 22, 2010. The medical record revealed the consent form for patient #1 stated, "patient unable to sign," and was witnessed by two nurses. The medical record revealed no documented evidence the patient's State Guardian was notified of patient #1's visit to the Emergency Department.

A review of four other medical records was conducted on June 22, 2010. Patient #3 did not have a signed consent. The medical record for patient #3 revealed the consent form stated, "patient unable to sign," and was witnessed by two nurses. The medical record revealed no documented evidence that patient #1's responsible party or guardian was notified of the patient's visit to the Emergency Department.

Interviews were conducted on June 22, 2010, at 10:00 a.m., with the Emergency Department Director and three Emergency Department Registered Nurses. All four nurses stated that consent for treatment was signed prior to treatment, unless the patient was an emergency and could not sign the consent and no one was available with the patient to sign the consent. The consent was then required to be obtained as soon as possible, according to the nurses. If the patient was transferred from the nursing home, the nurse would get report from the staff at the nursing home and would ask if the next of kin had been notified. The nurses stated if the patient from the nursing home was unable to sign the consent and no one was with the patient, then two nurses would document the patient was unable to sign the consent and both the nurses would sign the consent. All four nurses stated they had never notified or asked consent from a State Guardian to treat a patient.

An interview was conducted with the Director of Nursing (DON) on June 22, 2010, at 10:30 a.m. The DON stated that consent for treatment should be obtained for every patient. If a patient from the nursing home presented to the Emergency Department and was unable to sign the consent, phone consent should be obtained. The DON assumed that staff was calling and obtaining consent from the patient's power of attorney or guardian.