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Based on observation, record review, and interview, the facility failed to meet the Condition of Participation (CoP) for Patient Rights by not providing an appropriate way to notify staff if patients have any needs and did not provide basic needs like hydration.

The findings are:

A. Refer to Tag A-0144

Based on observation, record review and interview the facility failed to ensure the safety of patients in their care by not providing an appropriate way to notify staff if patients have any needs and did not provide basic needs like hydration for 2 (P [patient] 1 and P11) out of 3 (P[patient] 1, 5, and 11) patients reviewed for receiving care in the emergency department. This deficient practice can lead to patients not getting their basic needs met such as nutrition, toileting, pain management and/or being left unable to contact staff for medical assistance.

The findings are:

A. Record review of P1's nurses notes found under "Interactive view" revealed a note dated 07/12/2023, 9: 24 AM that stated, "Pt [Patient] states that she has been here since Monday [sic] and has not been offered any water and per POTS [Postural Orthostatic Tachycardia Syndrome, a sudden change in heart rate when standing that can cause someone to pass out], [patient] has to have a certain amount of water daily. [Patient] states that [patient] has had to throw things into the hall of [name of unit] to get the nurses' attention and was unsuccessful. Patient has order for regular diet since 0600 [6:00 AM] yesterday (7/11/23) . . ."

B. Record review of P1's diet orders revealed an order dated 07/11/2023, 6:03 AM for an "Inpt [inpatient] Diet" meaning patient was allowed to eat and drink.

C. Record review of P1's oral intake found under "Interactive View" revealed that on 07/11/2023, 07/12/2023, and 07/13/2023 there was no oral intake documented, the first oral intake documented was 07/14/2023 7:00 PM.

D. During an interview on 09/20/2023 at 8:39 AM with S (staff) 8, Executive Director confirmed that it was not documented that P1 received anything to drink from 07/11/2023-07/12/2023.

E. During an interview on 09/20/2023 at 7:16 AM with P11 it was asked how they were told to get staff attention, it was stated, "I guess I'll shout." It was asked if this made her nervous about being able to get staff attention, they stated, "Yes."

F. During an observation on 09/20/2023 at 7:19 AM the call light in a patient room in the emergency department was pulled, a light outside the room came on for one minute, it went unnoticed by staff. No sound could be heard in the hallway while the light was on. At 7:22 AM staff was approached and was unaware that call light was going off.

G. During an interview on 09/20/2023 at 8:39 AM with S8, Executive Director it was asked if it was appropriate for patients to have to yell to get nurse's attention. It was stated, "It shouldn't be necessary."

H. During an observation on 09/20/2023 at 1:00 PM in the emergency department 12 beds located in the hallways were not provided with a way of notifying staff if a patient had any needs.

I. During an interview on 09/20/2023 at 1:00 PM with S7, Executive Director it was asked how the patients in the hall beds are expected to get a hold of staff, it was confirmed that they would have to yell for staff.