HospitalInspections.org

Based on staff interviews and review of documentation including medical records and hospital policies, the hospital failed to implement an effective system to ensure that patients and families with language barriers were able to communicate with staff in order to participate in care as required. This was evident in two of 19 patients reviewed and resulted in isolating patients from their care decisions.
The findings include:
Documentation review on 5/18/2015 at 16:30 PM revealed a hospital policy entitled, " Language Access " for patients and families with Limited English Proficiency (LEP). The hospital Language Access policy indicated that " the facility recognizes the rights of these patients and their families to have access to linguistically appropriate care through the use of auxiliary aids to ensure all LEP patients and their surrogate decision makers are able to understand their medical condition." The policy also specifically provided that the "use of family members, particularly children, and other individuals accompanying the patient should not be used as interpreters except in cases of extreme emergency situations and only until a professional interpreter is available." Additionally, the hospital has created and hired a new staff position (language access representative) to assist in managing language access concerns for hospital patients.
On 5/18/2015 at 4:45 PM the hospital risk manager provided the survey team a document entitled " Language Services Staff Meetings-2015 " indicating that staff training had been provided, but no signatures from any staff having ever attended said meetings were provided and in the following two of 19 patients reviewed during survey, over many days, multiple hospital staff isolated patients from their care planning when they failed to obtain interpretive services in non-emergency situations.

1. Patient #9 who had LEP presented to the emergency department on 5/15/15, was subsequently admitted to receive acute care services, and was still in the hospital at the time of the survey on 5/18. During this admission, the language access representative assessed the patient and documented in the medical record that " there was no reason [why patient #9] could not use the phone interpreter service. "
However, medical record review on 05/18/2015 at 15:00 PM revealed that the language access service had only two notations for the language access service during the three days patient #9 had been in the hospital, and only one of these two was actually was placed to include the patient in care decisions. Interpreter phone service documentation was first noted 5 hours after initial assessment in the ED on 05/16/2015 at 00:05 AM to explain the patient diagnosis, treatment, and medication instructions. More than 48 hours later, the second interpreter service was noted on 05/18/2015 at 10:15 AM. This second language line call was not to discuss patient care but rather was placed by the interpreter services representative to explain and assess use of the interpreter phone service.
Documentation revealed that patient #9 was able to participate in care decisions if staff would only use the available language line. However, a Speech/Language Therapist (SLT) blamed the patient ' s cognitive status for not engaging the language line. On 5/18/15 at 9:13 AM the SLT documented that the patient was " unable to use language line d/t cognitive deficits " and that the patient was not " following directions for language line." There was no documented description of specific behaviors/examples supporting the therapist ' s conclusion that patient #9 was not able to follow instructions and no attempt to actually call the language line was documented. These findings were confirmed on chart review with the risk manager on 05/18/2015 at 15:00 PM.
During a 5/18/15 interview at 15:10 PM, the registered nurse providing care to patient #9 revealed that he/she RN assumed the patient could not use the language line and had therefore not attempted to. Specifically, the RN stated that he/she had worked with the patient during a the current and during a prior admission and " he can't handle using the interpreter phone with his neurological status. " Furthermore and contrary to hospital policy, the registered nurse added, " I use the family."
Again, when interviewing the Language Access representative on 05/18/2015 at 15:50 PM about Patient #9 and her documentation noted on 05/18/2015 at 10:15 AM she stated that "I used the interpreter phone to discuss the interpreter services and documented this call. There was no reason I found that this patient can't use the phone interpreter service. "
2. Patient #8 and his/her family members were documented with language barriers and the record indicated patient #8 may also have had cognitive barriers. (Documentation revealed that patient #8 had cognitive limitations that were evident at times but not always during the hospital stay.) Nonetheless, hospital staff relied on the LEP family members to interpret for the LEP patient who was sometimes cognitively impaired, with no documented evidence that any hospital staff ever assessed the patient or family member capacity to engage and use professional interpretive services to ensure communication about the patient ' s care would be clear, safe, and effective. Relying on LEP family to interpret for an LEP in violation of both the regulatory requirements and hospital policy greatly increased the risk for communication failures and for resultant patient harm.
Similar to patient #9, documentation faxed from the Risk Manager to the surveyor on 05/21/2015 for Patient #8 revealed that over 2 days, there were only two attempts to engage interpretive services for patient #8. The first attempt to use interpreter services was on 05/18/2015 at 11:00 AM (2 days after admission- Patient #8 admitted on 05/16/2015). The second language access note was on 5/18/2015 at 14:00 PM using an "in-person" interpreter who discussed the diagnosis and treatment, medication instructions, nutrition instructions, and fall risk precautions.
Review of the medical record on 05/18/2015 at 10:05 AM for Patient #8 revealed that the patient arrived to the Emergency Department (ED) on 05/16/2015 at 03:04 AM. An ED triage note revealed that patient #8 was Vietnamese, had communication "barriers and/or deficits present " and last that these barriers included that he/she was " non-English speaking... [and] the patients preferred language is Vietnamese." The patient arrived with an immediate family member and hospital staff immediate began relying on LEP family members to interpret for the cognitively impaired LEP patient. The neurological exam indicated that the patient " appears to have significant cognitive deficits as unable to obey instructions even with translation, however appears baseline per family." In addition to the note suggesting this translation in the ED was conducted by family, no documentation of any assessment of or engagement with the professional interpretive service was found documented in the record at this time.
A later renal consult record entry on 05/18/15 at 07:46 AM, specifically noted that patient #8 ' s " mentation appears normal." Nonetheless hospital staff repeatedly relied on LEP family to translate for the LEP patient. Medical record documentation included:
On 05/16/2015 at 13:00 PM, "non-English speaking, per family alert and oriented."
On 05/17/2015 at 16:00 and 16:05 PM a hospital social worker documented that he/she obtained a partial and " short " social history due to the " language barrier from daughter."