HospitalInspections.org

Based on record review and interview, the hospital failed to ensure consent to treat reflected the legal status and the ordered level of care for five (Patient #1, #2, #5, #14, and #15) of 15 patients.

This failed practice has the likelihood to result in the impedance on the right to receive care in the least restrictive setting. (See Tag 117)

Based on record review and interview, the hospital failed to ensure staff used approved consent to treat document for two (Patient #3 and #14) of 15 patient admissions.

This failed practice has the likelihood to put patients at risk of not fully understanding their treatment options, thereby reducing their capacity to participate in treatment planning and in the request or refusal of treatment, and impeding the right to receive care in the least restrictive setting. (See Tag 131)

Based on observation and interview, the hospital failed to ensure the patient (Room #6) was free of sharps for patients for behavioral disturbances.

This failed practice placed all patients in the facility at an increased risk of harm and injury. (See Tag 144)

Based on record review and interview, the hospital failed to ensure consent to treat reflected the legal status and the ordered level of care for five (Patient #1, #2, #5, #14, and #15) of 15 patients.

This failed practice has the likelihood to result in the impedance on the right to receive care in the least restrictive setting.

Findings:

A review of a facility document titled "Conditions of Admission and Services...Consent to Treat," in the medical records showed patient admission as Emergency Order of Detention (EOD) with an EOD date listed as:

Patient #1: EOD date 08/21/19
Patient #2: EOD date 06/18/19
Patient #5: EOD date 07/day illegible/19
Patient #14: EOD date 10/04/19
Patient #15: EOD date 10/14/19

A review of the medical records for patients #1, #2, #5, #14, and #15 showed no court order for Emergency Detention and patient admission upon the assessment of a Licensed Mental Health Professional Statement (LMHP).

On 10/17/19 at 4:30 PM, Staff I stated "EOD" should not be checked on the Conditions of Admission and Services...Consent to Treat document unless the patient had been adjudicated by a judge.

Based on record review and interview, the hospital failed to ensure staff used approved consent to treat document for two (Patient #3 and #14) of 15 patient admissions.

This failed practice has the likelihood to put patients at risk of not fully understanding their treatment options, thereby reducing their capacity to participate in treatment planning and in the request or refusal of treatment, and impeding the right to receive care in the least restrictive setting.

Finding #1:

A review of the "Board of Advisors Meeting Minutes" dated 01/31/19 showed, "Consent to Treat. Review of consents were done via local lawyers. Updated forms reviewed. Reviewed and approved by vote of the Board."

A review of the updated facility form titled, "Conditions of Admission and Services...Consent to Treat," read in part, "Consent to Treat...Request for Discharge: If the Undersigned wishes for the Patient to leave the hospital during inpatient treatment, whether the Undersigned is a Patient aged 16 years old (or older) or a person authorized by law to consent and/or revoke/withdraw consent on the Patient's behalf such as a custodial parent, guardian, guardian advocate or health care surrogate/proxy, the Undersigned agrees by signing below to provide written notice to a hospital staff member of the request to leave or discharge the Patient. Further, the Undersigned acknowledges that a treating physician may release the patient according to this request unless the treating physician determines that the patient poses a threat of harm to him/herself or others. A Patient has the right to leave unless: (a) the Undersigned changes his/her mind and does so in writing; (b) a Licensed Mental Health Professional believes the Patient meets criteria for involuntary commitment; or (c) the Patient is 17 years of age or younger and arrangements have not been made for discharge into the care, custody or protection of a custodial parent or legal guardian."

A review of the "Conditions of Admission and Services...Consent to Treat" document showed no updated language for:
Patient #3: with a patient signature date of 10/17/19
Patient #14: with a patient signature date of 10/10/19

On 10/18/19 at 11:14 AM, Staff D reviewed the "Conditions of Admission and Services...Consent to Treat" document for Patient #3 and stated, "Looks like our therapists are using the old form."

Based on observation and interview, the hospital failed to ensure the patient (Room #6) was free of sharps for patients for behavioral disturbances.

This failed practice placed all patients in the facility at an increased risk of harm and injury.


Findings:

On 10/15/19 at 3:36 pm, a metal cover with four square edges not flush on the wall was observed on the East wall of the entry, for Room #6 on Unit 1 (Oklahoma City site location).

On 10/17/19 at 3:57 pm, Unit 1, Room #6, the same metal cover was observed to not have caulking on two of the four edges.

On 10/15/19 at 3:36 pm, Staff C stated they would instruct staff to caulk around the sharp edges.

Based on patient record review and interview the hospital failed to ensure the patient plan of treatment was updated to reflect changes in care for two (Patient #4 and #11) of 15 patients.

This failed practice has the potential to result in the patient receiving treatment that is not current with orders and thereby delay therapeutic treatment and quality of care.


Findings:

A review of a hospital policy titled, "Treatment Planning Policy," read in part, "Medications, diagnosis, and initial goals and objectives will be included. This information will be included in the master treatment plan."

A review of Patient Records Showed:

Patient #4
A review of the patient record showed no update to the treatment plan for Patient #4 to reflect a physician order for finger stick blood sugars (FSBS) before meals.

Patient #11
A review of the patient record showed no updated plan of treatment for Patient #11 to reflect a physician order on 10/16/19 for Prednisone tapered dose for chronic obstructive pulmonary disease (copd).


On 10/17/19 at 2:00 pm, Staff G stated a physician order for finger stick blood sugars before meals was not added to the plan of treatment for Patient #4 because staff knew to automatically obtain finger stick blood sugars before meals on all patients that are diabetic, whether or not there was a physican order and a physican order for Prednisone tapering was not added to the plan of treatment for Patient #11 because medications were not listed on plans of treatment.

Based on patient record review and interview the hospital failed to ensure the medical history and physical exam (H & P) was signed by the physician within 24 hours of admission for one (Patient #5) of 15 patients.

This failed practice has the likelihood to place patients at risk for affecting the quality of patient care; as the patient record provides communication of patient care in a sequential manner to promote timely assessment and intervention.


Findings:

A review of a hospital policy titled, "Elements of the Medical History and Physical," read in part, "history and physical examinations will be completed within 24 hours of admission."


A review of Patient Records Showed:

Patient #5 Admitted to the hospital on 07/17/19, and as of 10/19/19 the H & P was not signed by the Physician (92 days after admission).


On 10/17/19 at 2:00 pm, Staff G stated the Physician did not sign the H & P on Patient #5.