HospitalInspections.org

Based on a review of job descriptions, staffing, and interviews with staff, the hospital failed to ensure that the in-patient psychiatric unit had a qualified Director of Psychiatric Nursing with a masters degree in psychiatric and mental health nursing, or its equivalent. The findings include:

Review of nursing staffing on the in-patient psychiatric unit failed to identify a Director of Nursing (DNS). Interview with the Vice President (VP) of Patient Care Services on 4/13/10 identified that he/she was the Director for in-patient psychiatry and had delegated the Nurse Manager to function in the DNS capacity, and had delegated a non-nurse administrator to oversee the Behavioral Health Program. Review of the VP's job description failed to identify that he/she was the DNS of psychiatry and failed to demonstrate that he/she held a masters degree in psychiatric and mental health nursing. Review of the Nurse Manger's job description and employee file failed to identify that the manager held a masters degree in psychiatric and mental health nursing. In addition, the VP failed to demonstrate competence in interdisciplinary formulation of individual treatment plans, psychiatric nursing care and therapy; and/or the direction, monitoring, and evaluation of psychiatric nursing care furnished.

Based on clinical record reviews, review of policies, and interviews with staff for 3 of 3 patients (Patients #3, #13 and #37) who were admitted for psychiatric treatment, treatment plans were not integrated, lacked patient specific interventions, and failed to identify groups that the patients should attend. The findings include:

a. Patient #3 was admitted on 2/20/09 for in-patient psychiatric treatment. The treatment plan (care plan) was reviewed with the nurse manager, director of behavioral health, and nursing computerization representative on 4/13/10 at 11:30 AM. Staff identified problems of ineffective coping and alteration in thought process. Review of the computerized treatment plan identified a lack of clear patient specific interventions related to each stated problem. The treatment plan was developed and maintained by nursing staff, did not include any documented input from the psychiatrist, and between 2/20/09 and 2/25/09, the treatment plan contained one entry each from social work and occupational therapy. However, the two disciplines did not identify interventions specific to the patient ' s stated problems. In addition, the treatment plan failed to identify specific groups the patient should attend, as related to his/her stated problems. The hospital policy for " Clinical Documentation Using Knowledge-Based Charting " identified that charting would provide and communicate integrated, interdisciplinary and individualized care.

b. Patient #13 was admitted on 4/7/10 for in-patient psychiatric treatment. Staff identified a problem of suicide risk, but the clinical record lacked clear patient specific interventions related to the stated problem of suicide risk. The treatment plan was developed and maintained by nursing staff, did not include any documented input from the psychiatrist. In addition, the treatment plan failed to identify specific groups the patient should attend, as related to his/her stated problems.

c. Patient #37 was admitted on 4/6/10 for in-patient psychiatric treatment. Staff identified a problem of an alteration in thought process related to audio-hallucinations and increased psychosis. The clinical record lacked clear patient specific interventions related to the stated problem of suicide risk. The treatment plan was developed and maintained by nursing staff and did not include any documented input from the psychiatrist. In addition, the treatment plan failed to identify specific groups the patient should attend, as related to his/her stated problems.