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Based on interview and record review the hospital failed to ensure a safe environment was provided for both hospital personnel and 1 of 1 patient (Patient #1). (Patient #1) arrived in the hospital's main ED (Emergency Department) with a loaded gun in her purse. (Patient #1) was transferred to the Psychiatric ED where hospital personnel delayed a search/scan of the patient and her belongings prior to being assessed. This failure placed all patients and hospital personnel within the vicinity of (Patient #1) at risk for injury.

Findings included:

(Patient #1's) main emergency services encounter record reflected, "arrival date 04/24/12 at 02:03 AM...escorted by EMS...emergent...bipolar; off medications..."

The Main ED nursing note dated 04/24/12 at 03:18 AM reflected, "Pt (patient) presents with depression and reports being off medications times 5 days and has been drinking excessive ETOH (alcohol)...pt appears flat, tearful, depressed and paranoid but cooperative and pleasant with staff...sitter at bedside for safety..."

The Psychiatric Services Patient Log for 04/24/12: reflected, "(Patient #1) arrived on the Psychiatric ED unit at 06:15 AM..."

The Psychiatric ED nursing note dated 04/24/12 timed at 09:28 AM reflected, "Late entry for 07:00 AM ...pt found to have a gun in her purse. Pts (patient's) gun was a 38 caliber revolver...police called to confiscate the weapon...Dr. notified...charge nurse notified..."

The Psychiatric ED nursing note dated 04/24/12 timed at 10:34 AM reflected, "This 40 year old female was escorted to psych ED by a nurse and a police officer. The patient was taken into the family room by (Staff #7), as there was a pt in the intake room. I joined the interview and the patient admitted she had been "drinking way too much last night. It was a stupid thing to do." She had told the Dr. that she had recently moved back to...had ended a 12 year relationship, is not currently employed and she feels stressed because she doesn't know anyone in the area. The patient is calm, but tearful...denies suicidal, homicidal ideations...she was somewhat upset when the Dr. told her she would need to stay in the psych ER until her alcohol level dropped at or below 80 and that this would be several hours from now. She asked to speak to someone else...Dr. left to get attending who also informed her of the need for her to remain until she became legally sober...the patient left the family room and went into the intake room across the hallway...the patient's vital signs were taken...Psych Tech was asked to secure her belongings while I got the patient a cup of water. I gave the patient a large cup of ice water and left the intake area to give a hand off report to the oncoming shift..." No documentation was found which indicated a search and scan was completed upon arrival to the psychiatric ED unit and/or prior to being assessed.

The Psychiatric ED nursing note dated 04/24/12 timed at 07:00 AM reflected, "Patient found to have a gun in her purse...patient's gun was a 38 caliber revolver...police called to confiscate the weapon... notified of situation. Dr...notified of situation...charge nurse notified of the situation..."

On 05/04/12 at 16:00 PM Staff #1 was interviewed. Staff #1 stated (Patient #1) arrived in the ED via ambulance. He stated patients are not searched when they come through the ambulance entrance. The patient was seen in the main ED and then sent to the psychiatric ED. He stated during the search and scan the technician found a loaded 38 caliber gun.

On 05/16/12 at 09:30 PM Staff #4 was interviewed by phone. Staff #4 stated he did not remember who brought the patient into the unit and put her in the interview room without being searched and scanned. Staff #4 stated when he went into the room (Patient #1's) purse was on the desk. Staff #4 said he began to do a property check and found the gun. Staff #4 stated he reported this to nurse. Staff #4 stated patients are frequently brought into the interview room before they are searched and scanned especially if they are voluntary. Staff #4 stated males could not search females it had to be same sex. Staff #4 stated four male technicians and two female nurses worked the morning of 04/24/12. Staff #4 said when there are no female technicians the female nurses are supposed to do the search/scan.

On 05/17/12 at 10:40 AM, the surveyor interviewed Staff #5. Staff #5 stated he had come on duty a little early on 04/24/12. Staff #5 said the patient was in the interview room with her purse on the other side of the desk. Staff #5 stated Staff #6 gave him report. Staff #5 stated the tech informed him the patient had a gun in her purse. He stated the police was notified and management was notified. Staff #5 stated Staff #6 did not follow procedure. The patient was not searched and scanned, nor were her belongings secured before she made it into the interview room. Staff #5 said the male technician could not do the search/scan as he was a male and (Patient #1) was female.

On 05/17/12 at 01:56 PM Staff #7 was interviewed. Staff #7 stated when (Patient #1) arrived the attending physician told her to take the patient in the family room as the interview room had a patient in it. Staff #7 stated she took Patient #1 in the room. Staff #7 said (Patient #1) had her purse with her. Staff #7 stated Staff #6 joined her approximately 10 minutes later in the interview room with (Patient #1). Staff #7 said she was aware search/scan was completed on patients but did not know when it was to be completed as part of the procedure. Staff #7 stated from the family room Staff #6 took (Patient #1) into the interview room. Staff #7 said she found out later (Patient #1) had a gun in her purse.

The Department of Clinical Staff Services Educational Event Record dated 04/24/12, 04/27/12, 04/30/12 and 05/01/12: reflected, "Given the incident happening 04/24/12 morning...it is important the patient property is secured...before the patient enters in the ante room for assessment...next the patient should be searched and scanned...the search and scan protocol should be done on each and every patient without fail. Once the search and scan is complete the admission process can continue...our goal is to keep the patient and staff safe..."

The Patient Search and Scan Policy with a revision date of 02/12: reflected, "In order to provide a safe environment for patients, staff, and visitors all individuals and belongings are searched and scanned at entry to the Psychiatric Emergency Services Department...a systematic search by the RN or technician, utilizing a hand-held metal detector (wand)...a systematic search by the RN or technician, who performs a pat down on a same sex patient ...belonging search...a systematic search by the RN or technician all belongings the patient brings to the department...visual inspection precedes physical search...on presentation the patient is physically separated from any bags, suitcases, purses, or other containers...access to these items is not permitted until the belongings search is completed...the search is done by the same sex staff..."