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The hospital failed 1 of 1 Patient (Patient #6) by which a medical doctor responsible for the care of a Medicare patient with respect to medical problem that was present on admission during hospitalization did not improve or was not properly addressed by the physician.

Findings Include:

During interview with hospital Staff #7 reported "Patient # 6, was discharged in the same conidtion that she was admitted in."
During interview with hospital Staff #7 reported, "Medical records were given to her by the complainant and she gave them to the doctor, and that is when the Patient recieved IV for dehydration."
During interview with hospital Staff #10 reported, "We do not want to put the patient through the process again to obtain labs, if they have already completed them prior to admission."
During interview with hospital Staff #9 reported, "The medical doctors are responsible for overseeing patient medical conditions, and this was out the psychiatric scope. However, I will advise the medical team of what I see the problem to be."

During record review hospital Patient #6 was reported to be dehydrated.
During record review the medical evaluation reflected, "No new labs ordered, lab results received from family per Staff #9's request in patient's chart. 08/24/2021 09:16."
During record review of the Hospital Nutrition and Hygiene Sheets Patient #6 consumed less 60% of her food the entire 4.5 days in the hospital.

Policy
The hospital Policy on Patient Rights dated 07/2021 reflected,
1.) The list of Patient Rights and Responsibilities (PRR) is provided to each patient at admission as part of the admission packet. The PRR prints from Medi-tech as a part of the admission packet.
a. The list is also posted prominently in the hospital where patients, families and their legal representatives can view it.
b. Admission materials also include information concerning how to access the Kindred Compliance Program as well as other state, federal and accreditation agencies. B-ML 04-008 CORE: Compliant and Grievance Process
2.) The patient, or patient's authorized representative, acknowledges receipt of the Patient Rights and responsibilities by initial or signature on the admission checklist."

The hospital Policy on Quality of Care dated 02/1/2017 reflected, "A hospital shall develop, implement, and maintain an effective ongoing, hospital-wide, data driven quality assessment and performance improvement program ...Reflect the complexity of the hospital organization .... Involve all hospital departments and services, Specify the frequency and detail of data collected, Focus on high-risk, high volume, and problem prone areas."

The hospital Policy on Neglect dated 06/2021 reflected, "Prohibited abuse and describe the procedures for preventing and responding to allegations of abuse, neglect or mistreatment of a patient. To identify the hospital's position regarding employees who are suspected of patient abuse neglect or exploitation. The hospital maintains a strict policy to prevent or respond to allegations of neglect including prompt reporting of any alleged abuse incident to hospital leaders and applicable state agencies. Failure to report immediately a suspected abuse incident or incorporate in the appropriate investigation can result in corrective action."
"NEGLECT/MISTREATMENT: is the failure or refusal by any person having the care or custody of another to exercise the degree of which a reasonable person in a like position would exercise ...
a. Failure to provide the prescribed medical care and treatment for their physical and mental health needs
d. Failure to provide sufficient food and fluids to prevent malnutrition and dehydration, including unauthorized removal or unauthorized denial of a patient's scheduled means or snacks.

The hospital Policy on Dietary Services dated 06/2019 reflected, "Nutrition Services-Nutrition Prescription Process, an order for an oral diet is written to match the standard diets provided by the facility and planned on the therapeutic diet menu. Eternal and parenteral nutrition orders are written to follow the standard formulary. If the order does not match one of the standard diets, the nurse consults with the registered dietitian (RD) for assistance ...Orders for oral diets are communicated to the Nutritional Services department electronically or in writing within two hours of the order transcription.


The hospital Policy on Nutrition Services-Food and Fluid Intake dated 06/2019 reflected, "Daily monitoring of patient's food and fluid intake.
Accurate documentation of meal, snack and supplement intake in the medical record.

The hospital Policy on Nursing Services dated 05/2021 (Service Delivery and Organization); The Plan is reviewed annually and revised appropriately. The Leadership Nursing Plan for Patient Care includes;
" Care that is directed toward the restoration of health, reaching the patient's full potential and improving each patient's quality of life.
" Reference and Follow the American Nurse Association Standards of Nursing Care;
o Assessment - the registered nurse collects comprehensive data pertinent to the healthcare consumer's health and/or the situation.
o Diagnosis - The registered nurse analyzes the assessment data to determine the diagnoses or the issues.
o Outcome Identification - The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation.
o Planning - The registered nurse develops plan that prescribes strategies and alternatives to attain expected outcomes.
o Implementation - The registered nurse implements the identified plan.
o Coordination for Care - The registered nurse coordinates care delivery
o Health Teaching and Health Promotion - The Registered nurse employs strategies to promote health and a safe environment.
o Consultation - The graduate level prepared specialty nurse or advance practice registered nurse provides consultation to influence the identified plan, enhance the abilities of others, and effect change.
o Prescriptive Authority and Treatment - The advanced practice registered nurse uses prescriptive authority procedures, referrals treatments, and the therapies in accordance with state and federal laws and regulations.
o Evaluation - The registered nurse evaluates progress toward attainment of outcomes.

The hospital failed 1 of 1 Patient (Patient #6) by not ensruing that a nursing care staff developed, and kept current, nursing care plan for Patient #6 that reflected Patient #6's goals and the nursing care to provided to meet the patient's needs.

Findings Include:
During record review The Hospital Physician Orders dated 08/24/2021 at 11:45AM "2L normal saline IV stat for dehydration."
Duriing record review General Progress Note dated 08/24/2021 at 1540, "per patient's labs sent from complainant patient is dehydrated. 2l of fluids ordered by medical doctor. IV line started and fluids administered on date of discharge."

During Interview with Hospital Staff #7 Patient #6 condition did not change since her admission into the hospital. Staff #7 indicated obtaining the medical records from the family and providing them to doctor on 08/24/21.
During Interview with Hospital Staff #9 there were no new labs ordered. The patient may have been consuming enough fluids to stay hydrated.
During Interview with Staff #10 the it was out of scope of practice. Staff #10 was asked if when visiting with the patient or physician assistant visited was it reported or suggested there were medical issues that needed to be addressed. Staff #10 indicated that it was not identified by them, but would advise medical team if noticed. That is not our scope of practice.

The hospital Policy on Patient Rights dated 07/2021 reflected,
1.) The list of Patient Rights and Responsibilities (PRR) is provided to each patient at admission as part of the admission packet. The PRR prints from Medi-tech as a part of the admission packet.
a. The list is also posted prominently in the hospital where patients, families and their legal representatives can view it.
b. Admission materials also include information concerning how to access the Kindred Compliance Program as well as other state, federal and accreditation agencies. B-ML 04-008 CORE: Compliant and Grievance Process
2.) The patient, or patient's authorized representative, acknowledges receipt of the Patient Rights and responsibilities by initial or signature on the admission checklist."

The hospital Policy on Quality of Care dated 02/1/2017 reflected, "A hospital shall develop, implement, and maintain an effective ongoing, hospital-wide, data driven quality assessment and performance improvement program ...Reflect the complexity of the hospital organization .... Involve all hospital departments and services, Specify the frequency and detail of data collected, Focus on high-risk, high volume, and problem prone areas."

The hospital Policy on Neglect dated 06/2021 reflected, "Prohibited abuse and describe the procedures for preventing and responding to allegations of abuse, neglect or mistreatment of a patient. To identify the hospital's position regarding employees who are suspected of patient abuse neglect or exploitation. The hospital maintains a strict policy to prevent or respond to allegations of neglect including prompt reporting of any alleged abuse incident to hospital leaders and applicable state agencies. Failure to report immediately a suspected abuse incident or incorporate in the appropriate investigation can result in corrective action."
"NEGLECT/MISTREATMENT: is the failure or refusal by any person having the care or custody of another to exercise the degree of which a reasonable person in a like position would exercise ...
a. Failure to provide the prescribed medical care and treatment for their physical and mental health needs
d. Failure to provide sufficient food and fluids to prevent malnutrition and dehydration, including unauthorized removal or unauthorized denial of a patient's scheduled means or snacks.

The hospital Policy on Dietary Services dated 06/2019 reflected, "Nutrition Services-Nutrition Prescription Process, an order for an oral diet is written to match the standard diets provided by the facility and planned on the therapeutic diet menu. Eternal and parenteral nutrition orders are written to follow the standard formulary. If the order does not match one of the standard diets, the nurse consults with the registered dietitian (RD) for assistance ...Orders for oral diets are communicated to the Nutritional Services department electronically or in writing within two hours of the order transcription.


The hospital Policy on Nutrition Services-Food and Fluid Intake dated 06/2019 reflected, "Daily monitoring of patient's food and fluid intake.
Accurate documentation of meal, snack and supplement intake in the medical record.

The hospital Policy on Nursing Services dated 05/2021 (Service Delivery and Organization); The Plan is reviewed annually and revised appropriately. The Leadership Nursing Plan for Patient Care includes;
" Care that is directed toward the restoration of health, reaching the patient's full potential and improving each patient's quality of life.
" Reference and Follow the American Nurse Association Standards of Nursing Care;
o Assessment - the registered nurse collects comprehensive data pertinent to the healthcare consumer's health and/or the situation.
o Diagnosis - The registered nurse analyzes the assessment data to determine the diagnoses or the issues.
o Outcome Identification - The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation.
o Planning - The registered nurse develops plan that prescribes strategies and alternatives to attain expected outcomes.
o Implementation - The registered nurse implements the identified plan.
o Coordination for Care - The registered nurse coordinates care delivery
o Health Teaching and Health Promotion - The Registered nurse employs strategies to promote health and a safe environment.
o Consultation - The graduate level prepared specialty nurse or advance practice registered nurse provides consultation to influence the identified plan, enhance the abilities of others, and effect change.
o Prescriptive Authority and Treatment - The advanced practice registered nurse uses prescriptive authority procedures, referrals treatments, and the therapies in accordance with state and federal laws and regulations.
o Evaluation - The registered nurse evaluates progress toward attainment of outcomes.

The hospital failed 1 of 1 Patient (Patient #6) by failing to accurately document the patients current status at the time of discharge.


Findings Include:
During record review the hospital Discharge Summary reflected, "Medically stable, with patient appearing in no acute physical distress on discharge, albeit still with poor appetite, rehydration intervention initiated prior to patients discharge at family request on 08/24."

During record review the hospital Ordered IV fluids, after review of the medical records recieved from an outside provider.
During record review the hospital ordered no new labs on evaluation.
During interview with the complainant upon discharge Patient #6 was taken to another hospital for continued services for 4 days where the patient was diagnosed with the following: ( Malnutrition, Urinary Tract Infect, Bladder Infection and her kidneys were starting to fail.)

During interview with hospital staff #9, we do not want to put the patients through the process of obtaining new lab if they had them completed prior to admission. The hospital staff #9 did not order new labs or request recent labs from outside source.












The hospital Policy on Patient Rights dated 07/2021 reflected,
1.) The list of Patient Rights and Responsibilities (PRR) is provided to each patient at admission as part of the admission packet. The PRR prints from Medi-tech as a part of the admission packet.
a. The list is also posted prominently in the hospital where patients, families and their legal representatives can view it.
b. Admission materials also include information concerning how to access the Kindred Compliance Program as well as other state, federal and accreditation agencies. B-ML 04-008 CORE: Compliant and Grievance Process
2.) The patient, or patient's authorized representative, acknowledges receipt of the Patient Rights and responsibilities by initial or signature on the admission checklist."

The hospital Policy on Quality of Care dated 02/1/2017 reflected, "A hospital shall develop, implement, and maintain an effective ongoing, hospital-wide, data driven quality assessment and performance improvement program ...Reflect the complexity of the hospital organization .... Involve all hospital departments and services, Specify the frequency and detail of data collected, Focus on high-risk, high volume, and problem prone areas."

The hospital Policy on Neglect dated 06/2021 reflected, "Prohibited abuse and describe the procedures for preventing and responding to allegations of abuse, neglect or mistreatment of a patient. To identify the hospital's position regarding employees who are suspected of patient abuse neglect or exploitation. The hospital maintains a strict policy to prevent or respond to allegations of neglect including prompt reporting of any alleged abuse incident to hospital leaders and applicable state agencies. Failure to report immediately a suspected abuse incident or incorporate in the appropriate investigation can result in corrective action."
"NEGLECT/MISTREATMENT: is the failure or refusal by any person having the care or custody of another to exercise the degree of which a reasonable person in a like position would exercise ...
a. Failure to provide the prescribed medical care and treatment for their physical and mental health needs
d. Failure to provide sufficient food and fluids to prevent malnutrition and dehydration, including unauthorized removal or unauthorized denial of a patient's scheduled means or snacks.

The hospital Policy on Dietary Services dated 06/2019 reflected, "Nutrition Services-Nutrition Prescription Process, an order for an oral diet is written to match the standard diets provided by the facility and planned on the therapeutic diet menu. Eternal and parenteral nutrition orders are written to follow the standard formulary. If the order does not match one of the standard diets, the nurse consults with the registered dietitian (RD) for assistance ...Orders for oral diets are communicated to the Nutritional Services department electronically or in writing within two hours of the order transcription.


The hospital Policy on Nutrition Services-Food and Fluid Intake dated 06/2019 reflected, "Daily monitoring of patient's food and fluid intake.
Accurate documentation of meal, snack and supplement intake in the medical record.

The hospital Policy on Nursing Services dated 05/2021 (Service Delivery and Organization); The Plan is reviewed annually and revised appropriately. The Leadership Nursing Plan for Patient Care includes;
" Care that is directed toward the restoration of health, reaching the patient's full potential and improving each patient's quality of life.
" Reference and Follow the American Nurse Association Standards of Nursing Care;
o Assessment - the registered nurse collects comprehensive data pertinent to the healthcare consumer's health and/or the situation.
o Diagnosis - The registered nurse analyzes the assessment data to determine the diagnoses or the issues.
o Outcome Identification - The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation.
o Planning - The registered nurse develops plan that prescribes strategies and alternatives to attain expected outcomes.
o Implementation - The registered nurse implements the identified plan.
o Coordination for Care - The registered nurse coordinates care delivery
o Health Teaching and Health Promotion - The Registered nurse employs strategies to promote health and a safe environment.
o Consultation - The graduate level prepared specialty nurse or advance practice registered nurse provides consultation to influence the identified plan, enhance the abilities of others, and effect change.
o Prescriptive Authority and Treatment - The advanced practice registered nurse uses prescriptive authority procedures, referrals treatments, and the therapies in accordance with state and federal laws and regulations.
o Evaluation - The registered nurse evaluates progress toward attainment of outcomes.