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Tag No.: A0129
Based on documentation and interviews, it was determined that the facility failed to ensure that for one of one patients (Patient #1) on the adolescent unit, he was allowed to exercise his right to visit with family members during visitation.
Findings included:
Review on 12/05/2017 of Facility Teen Bill of Rights revealed but was not limited to the following: "Personal Rights 5. You have the right to talk and write to your friends and family outside the hospital. This means you can write to people, get mail that hasn't been opened, call people, and have visitors. The hospital may have some rules about when you can have visitors or make phone calls. If you are not aware of what the rules are, ask someone."
Review on 12/05/2017 of Rights and Responsibilities of the Individual, last revised 01/25/2017 revealed but was not limited to the following: "D. A physician may restrict visitors if, in the medical opinion of the physician, if the visit is not in the best interest of the patient, and only with a physician's order indicating the clinical justification for the restriction. H. Patients who are restricted to the unit, may have visitors in designated areas on the unit, but visitation is contingent on the safety of the unit and may be interrupted or canceled if the milieu is not conducive to a visit as assessed by the Nursing Supervisor.
Review on 12/05/2017 of Facility Visitation Logs for the Adolescent Unit revealed the following:
09/20/2017 at 6:15 PM to 7:36 PM: Patient #1 had two visitors who arrived at 6:27 PM Visitation for patients was documented by facility staff as occurring from 8:00 PM to 8:30 PM for all patients listed who had visitors who arrived on this date and between those times.
10/03/2017 at 6:00 PM to 6:45 PM: Patient #1 had two visitors who arrived at 6:00 PM. Visitation for Patient #1 was documented by facility staff as not occurring due to Patient #1 being on Unit Restriction.
Interview during entrance conference on 12/05/2017 with facility administrative staff confirmed visitation for the adolescent unit occurred on Tuesday and Saturday from 6:00 PM to 8:00 PM.
Interview on 11/27/2017 at 2:20 PM with Patient #1's mother revealed that during the two scheduled visitations times she went to the facility to visit Patient #1, she was not allowed to visit with him. She stated that each time she attempted to visit, she was given unclear explanations by facility staff as to why she could not visit with Patient #1. She stated that on one of her attempts to visit him, she was told by an unknown facility staff that "children could have visitation privileges revoked for not following the rules".
Record review of Patient #1's medical record revealed he was a 16 year old male admitted to the facility on 09/28/2017 due to an overdose of Mucinex tablets.
Review of Patient #1's Physician Orders revealed but was not limited to the following: 09/28/2017 at 1630: Discontinue Unit Restriction. Continued review of Physician Orders during Patient #1's admission dates (09/28/2017 to 10/04/2017) did not reveal orders from a physician for Unit Restriction.
Interview on 12/05/2017 at 2:20 PM with Facility Nurse Manager for the Adolescent Unit revealed that almost all adolescents are placed on Unit Restriction by their physicians for the first 24 hours they are at the facility. She further stated that if an adolescent is again placed on unit restriction, a physician's order would be obtained.
Interview on 12/05/2017 in the afternoon with Facility Registered Nurse (RN) #1 revealed but was not limited to the following: RN#1 confirmed she worked as a PRN (as needed) nurse on the adolescent unit from 7:00 AM to 7:00 PM and sometimes she worked until 11:00 PM. She confirmed she worked on the adolescent unit on 09/30/2017 during adolescent visitation. She stated that Patient #1 was most likely restricted to the unit due to his behavior during this time and that is why the mother was unable to visit with him. She further stated that unit restriction is up to the judgement of the nursing staff and depends on the patient's behavior. She stated this decision is based on nursing judgement and nursing staff are not required to document the unit restriction time periods.
Interview on 12/05/2017 with facility administrative staff during the exit conference confirmed that a if a nurse decided a patient needed to be on unit restriction due to behaviors, the nurse would need to contact a physician for a physician's order to continue the placement of the patient on unit restriction.