HospitalInspections.org

Based on reviews of medical records and interviews with staff, it was determined the Registered Nursing staff failed to follow written hospital policy and physician's orders relative to monitoring a patient at risk for suicide in at least one (1) of ten (10) cases reviewed. (patient #1). This has the potential for inadequate monitoring of patients who are at risk for suicide.

Findings include:

Review of the hospital policy "Patient Monitorings", last reviewed 12/13, revealed that it states "Hospital staff closely monitor all patients at a minimum of 30 minute intervals. Patients whose mood, affect, actions, behavior or thought content indicate the need for more frequent observation will be placed on 15 minute intervals. Special precautions of 15 minute checks are required for patients that are at immediate risk for: Assault, Elopement, Suicide, Fall or Seizure." The policy also states "The physician will write orders for discontinuing precautions when a change in the patient's behavior deems it appropriate."

Review of medical record #1 revealed an adolescent patient was admitted on 2/25/2014. The physician's admission orders included "suicidal precautions". Upon admission, the patient was placed on "suicidal precautions" by the nursing staff as per the physician order, which included a face to face monitoring check every fifteen (15) minutes.

The fifteen (15) minute face to face checks were started at the time of admission as ordered and continued until 2/27/2014 at 7:00 a.m. when the patient was placed on an every thirty (30) minute check. There was no physician order to discontinue the suicidal precautions, as per hospital policy. Review of the physician, therapy and nursing progress notes revealed the patient voiced no suicidal ideations. There were no notes by any physician or nursing staff to indicate the suicidal precautions had been discontinued, per se, and there were no entries into the patient's master treatment plan to indicate the precautions had been discontinued. The only indication the patient's suicidal precautions had been discontinued was that the every fifteen (15) minute checks had been changed to every thirty (30) minute checks by staff.

The medical record was reviewed with the patient's attending physician, the Director of Patient Care Services, and the Director of Quality and Risk Management on 3/11/2014 at about 3:30 p.m. They all concurred there had been no written physician order to discontinue the suicidal precautions with the required every fifteen (15) minute monitoring, when the staff began to monitor the patient at an every thirty (30) minute interval on 2/27/2014.