HospitalInspections.org

Based on a review of hospital policies and staff interviews the hospital failed to provide a written response to a patient grievance.

Findings included:

Review of hospital policy, "Patient Advocacy / Grievance and Conflict Resolution", Policy Number RI-17, effective 6/10/13, stated, in part,
"A patient grievance would also include situations where patients or the patient's representative call or write to the hospital about concerns related to care or services that were not resolved during their stay or who did not wish to address their issue during their stay ...
9. Time frame for completion of the investigation is 72 hours after the receipt of the complaint, with written response within 7 days ...
11. Once the issue has been resolved, the staff person responsible for investigating and resolving the grievance will provide a written response within seven (7) days of the grievance/complaint being received. The response will include:
a) The name of the contact person,
b) The steps taken to investigate the grievance on behalf of the patient,
c) The results of the grievance process, how the grievance was resolved;
d) The date of completion of the investigation.
e) The process to follow if the patient/complainant is not satisfied with the response."

Review of facility documentation provided to the surveyor revealed a complaint call was received by the facility on 5/20/14 from the father of Patient #1, with documentation by Staff #13 stating that he called the complainant on 5/21/14. There was also documentation that Staff #6 called the complainant on 5/21/14.

In an interview with Staff #13, Director of Clinical Services the afternoon of 8/12/14 in the facility conference room, Staff #13 stated that he received a complaint from the father of Patient #1, after Patient #1 was discharged. The complaint involved nutrition, lost personal belongings, and patient phone calls. Staff #13 stated that he called the complainant and discussed the complaint with the father and stated that, "I spoke to the dad; when I was done, he didn't say anything else."

In an interview with Staff #6, hospital administrator the afternoon of 8/12/14 in the facility conference room, she stated that she spoke with the father of Patient #1 (complainant) about the complaint after Staff #13 spoke to him and she felt that everything was resolved by the end of the conversation.

In an interview with Staff#2, Risk Manager and Staff #13, Director of Clinical Services the afternoon of 8/12/14, Staff #2 and Staff #13 each stated that that there was no written response was provided to the complainant, the father of Patient #1, per hospital policy in response to his complaint/grievance to the hospital. Staff #2 stated that a written response was not provided if they felt the complaint was resolved.

The above findings were confirmed in an interview the afternoon of 8/12/14 in the facility conference room in an interview with the hospital administrator, risk manager, and shift supervisor.

Based on a review of medical records, staff interviews, and hospital policy, the hospital failed to ensure that nursing standards were met as evidenced by: patient dietary intake and needs were not addressed, meal intake was not documented for patients and a dietary consult was not ordered for a patient with appetite concerns. Interview and documentation revealed patient belongings were not secured and returned at patient discharge.

Findings included:

Review of the medical record for Patient #1 revealed the following:
Daily Provider Progress notes were as follows:
5/7/14 Staff #7 MD: "Appetite: Remains poor."
5/8/14 Staff #7 MD: "Appetite: Good"
5/9/14 Staff #8 APRN: "Appetite: Good"
5/10/14 Staff #8 APRN: "Appetite: Good"
5/11/14 Staff #8 APRN: "Appetite: Good"

Patient Observation/ MHT Progress Notes documentation for percentage of meals consumed was incomplete as the percentage was not documented/left blank for 16 out of 26 meals as follows:
Date Bkfast Lunch Dinner Snack
5/6/14 2 2 blank blank
5/7/14 blank blank blank blank
5/8/14 20 5 75 blank
5/9/14 blank blank blank blank
5/10/14 2 blank blank blank
5/11/14 50 blank 50 100
5/12/14 0 blank discharged discharged

12 Hour Nursing Assessment/Progress Note documentation for percentage of meals consumed was incomplete as the percentage was not documented/left blank for 16 out of 26 meals as follows:

Date Bkfast Lunch Dinner Snack
5/6/14 100 100 blank 100
5/7/14 30 blank blank blank
5/8/14 50 100 blank 100
5/9/14 blank blank blank blank
5/10/14 75 blank blank blank
5/11/14 100 blank blank blank
5/12/14 75 blank discharged discharged

There was only one nursing shift narrative note which mentioned the consumption of meals for Patient #1; on 5/7/14, nursing documentation stated, "states did not sleep well Appetite [decreased as indicated by arrow drawn pointing down]." There was no documented evidence of any intervention or dietary consultation.
Progress notes from the therapists included the following entry:
5/7/14 at 2:45 pm "Therapist spoke [with] [father] via phone - reviewed current progress in groups, medications & appetite."
There was no documented evidence in the medical record that Patient #1 received a dietary or nutrition consult, despite physician, nursing, and therapy documentation about the patient's appetite.

In addition to the record for Patient #1, review of an additional 4 out of 5 medical records (Patients #6, 8, 9, 10) revealed that dietary intake was not documented consistently by nursing staff.
Review of the medical record for Patient #6 revealed no documentation for 2 meals on 8/10/14 and 4 meals on 8/9/14.
Review of the medical record for Patient #8 revealed no documentation for 4 meals on 8/9/14 and 1 meal on 8/10/14.
Review of the medical record for Patient #9 revealed no documentation for 4 meals on 8/9/14 and 1 meal on 8/10/14.
Review of the medical record for Patient #10 revealed no documentation of 2 meals on 8/3/14 and 1 meal on 8/10/14.

In an interview with Staff #2, Risk Manager, the afternoon of 8/12/14, she confirmed that the nurses and the MHTs are required to document the percentage of meals consumed for each patient and confirmed the above findings in the patient records.

Review of hospital policy, "Documentation Guidelines", Policy Number PC-T-8, effective 6/10/13, stated, in part,
"Documentation of care and other therapeutic services will occur in a systematic manner, reflecting patient needs, current status, special occurrences and on-going progress ...
2. Each discipline or modality shall document in the indicated medical record form, utilizing standard medical record guidelines ..."

Review of hospital policy, "Multidisciplinary Approach to Generating Order for Nutritional Assessments - Consults", Policy Number PC-N-13, effective 6/10/13, stated, in part, "4. The nursing staff will continually monitor the patients' food intake and complete weight checks as established per policy and request consult by dietitian if there are appetite or weight status concerns."

Review of the Texas Nurse Practice Act ?217.11. Standards of Nursing Practice, stated, in part,
"(1) Standards Applicable to All Nurses. All vocational nurses, registered nurses and registered nurses with advanced practice authorization shall: ...
(D) Accurately and completely report and document:
(i) the client ' s status including signs and symptoms;
(ii) nursing care rendered; ...
(v) client response(s); and
(vi) contacts with other health care team members concerning significant events regarding client ' s status;"

Review of the medical record for Patient #1 revealed that the Patient Belongings Inventory form revealed a list of items were documented that Patient #1 brought with her to the hospital; Patient #1 signed the form on 5/5/14 and the form was witnessed by staff on 5/5/14. Patient #1 again signed the form on 5/12/14 which stated "Upon Discharge, all items have been returned to me." The checkboxes for "Yes" or "No" were left blank. The signature was witnessed by Staff #10 on 5/12/14.

In an interview with Staff #2, Risk Manager the afternoon of 8/12/14, she stated that patients complete a patient belongings inventory form when they are admitted to the hospital and they sign the form at discharge after the patient receives their belongings.

Review of the Austin Oaks Hospital Patient Feedback and Complaint dated 5/20/14, revealed that the father of Patient #1 called after the discharge of Patient #1 to state that Patient #1 didn't receiving clothing /toiletries on multiple drop offs, and that clothes taken from drop off were lost, but were found 10 minutes later.
Staff #13, Director of Clinical Services documented on 5/21/14 that he spoke to the father of Patient #1 and he was "greatful (sic) for our efforts to address his concerns ...He denied any further actions to be taken on our behalf."
On 5/21/14, a note was made and signed by Staff #6, Hospital Administrator, which stated, "I talked [with] father and he was very satisfied based on the conversations [with] therapists."

In an interview with Staff #13, Director of Clinical Services the afternoon of 8/12/14 in the facility conference room, Staff #13 stated that he received a complaint from the father of Patient #1 after her discharge, he reviewed the complaint and called the complainant. Per Staff #13, the father of Patient #1 stated that he had concerns that his daughter's clothes were lost, but Staff #13 was "pretty sure that the dad came back and got the clothes" when they were found after the patient was discharged. Staff #13 stated that, "I spoke to the dad; when I was done, he didn't say anything else."

Review of facility policy "Patient Valuables and Belongings", Policy Number RI-23, effective 6/10/13, stated, in part,
"Patient's belongings that are placed in the custody of the hospital will be logged in and secured and returned to the patient on discharge ...
6. The patient and staff then return to the unit, the staff inventories all items that will not be kept in custody by the patient during their stay ...
10. The patient or /parent / guardian will review the inventory list and sign it; staff member doing the inventory will sign and date it ...
16. At the time of discharge the following steps will be taken:
a. Unit staff will retrieve the Personal Belongings ...Patient and staff will sign and date form confirming receipt of items."

The above findings were confirmed in an interview the afternoon of 8/12/14 in the facility conference room with the Hospital Administrator, the Risk Manager, and the RN Shift Supervisor.