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Based on a review of medical records, policies and procedures, staff interviews, and observation, it was determined that the facility failed to provide adequate nursing services when one patient (P)#2 out of six sampled patients was not given his presecribed medications as per order.

Findings:
A review of Patient (P)#2's medical record revealed that P#2 was admitted to the facility via the emergency department involuntarily on 11/3/23 at 2:01 a.m. with symptoms of depression and suicidal ideation. P#2 was diagnosed with Major depressive disorder, recurrent episode, severe. P#2 had no prior inpatient psychiatric admission, but had outpatient counseling/medication management for Post Traumatic Stress Disorder (PTSD- a disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event), Attention-Deficit Hyperactivity Disorder (ADHD- chronic condition including attention difficulty, hyperactivity, and impulsiveness), and Oppositional Defiant Disorder (ODD- a disorder in a child marked by defiant and disobedient behavior to authority figures), and P#2 was on a regular medication of Prozac (medication used to treat depression), Clonidine (medication used to treat ADHD), and Methylphenidate (medication used to treat ADHD and excessive uncontrollable daytime sleepiness).

A review of the admission orders by Psychiatrist (PSY) FF on 11/3/23 at 11:00 a.m. revealed an order for suicidal precautions and every 15 minutes monitoring. Documentation revealed medication orders of Prozac, 1 capsule daily, Clonidine 1 tablet at bedtime, and Methylphenidate 1 tablet daily prescribed by PSY FF and signed on 11/3/23 at 6:05 p.m.

A review of the medication administration record revealed that the medications - Prozac, Clonidine, and Methylphenidate were not administered to P#2 on 11/3/23 and 11/4/23.

P#2 was discharged home in a stable condition on 11/6/23 with a diagnosis of Disruptive Mood Dysregulation Disorder (DMDD - a condition in which children or adolescents experience ongoing irritability, anger, and frequent, intense temper outbursts) and ADHD, to follow up with the primary care physician. P#2 was discharged home with Prozac, Methylphenidate, and Clonidine.

A review of the facility's "Patient Rights" policy, Policy#RI.003, last revised 1/23, stated that the patients have the right to receive care and treatment that is suited to their individual needs, to expect reasonable continuity of care, and to receive care that is administered skillfully, safely, and humanely with full respect for their dignity and personal integrity. Patients have the right to an explanation of their condition, medications, procedures for treatment, alternatives for care or treatment, and problems related to recuperation and probability of success. Patients have the right for such information to be afforded by their physician.

A review of the facility's "Medication Management - Ordering & Transcribing" policy, Policy No. 10-13, last revised March 2023 stated that orders to titrate medications shall be written according to this policy. The procedure to titrate orders are those in which the dose is either progressively increased or decreased in response to the patient's status. Titrate orders must meet the following: - The prescriber must specifically order the minimum and maximum dose - The parameter used to titrate (e.g. blood pressure) must be available on the patient care unit where the patient is being treated, and the nurse must be competent in reading and/or interpreting the parameter - The dosage increment used to titrate the medication must be written.

An interview occurred in the conference room on 11/21/22 at 10:05 a.m. with Chief Nursing Officer (CNO) BB who stated that P#2 missed his medications for two days due to an error in the interface that caused the order not to be transferred to the medication administration record (MAR).

During an interview with PSY FF, he stated that when P#2 was admitted, he (PSY FF) spoke to P#2's mom and also put in orders for P#2. PSY FF stated that he was not aware that P#2 did not have his medication for two days. PSY FF further stated that P#2 not receiving his medications as per order did not have any clinical effect on him (P#2) as two out of the three medications he (P#2) was supposed to have, are usually not given daily sometimes as the medications were only used on school days. However, the third medication (Prozac) he was supposed to have daily would not affect him if he missed it for a couple of days as the medication takes six weeks to be eliminated from the body.