HospitalInspections.org

18051

Based on record review. policy review and interviews, the facility failed to delineate frequencies for treatment modalities outlined on 6 of 8 active sample patient (C8, D1, D5, D9, E2 and E7) master treatment plans.

Specifically, the facility failed to prescribe frequencies for physician interventions for 2 of 8 active patients (D1 and D9); nursing interventions for 5 of 8 active patients (C8, D5, D9, E2 and E7); mental health associate interventions for 1 of 8 active patients (E2) and on 1 of 8 active patients (C8) interventions provided by the mental health associate were written with increased frequency from what was reflected on the posted unit program schedule; family therapist/social work interventions for 3 of 8 active patients (D1, D5 and D9); and activities therapy for 2 of 8 active patients (D1 and E2). These failures result in patients not having a clear understanding of what is expected of them while in treatment. There is also the potential for staff to work without having accurate guidance from the treatment team in care coordination and care delivery.

Findings Include:

A. Record Review

1. Patient C8, admitted 10/26/11, master treatment plan completed 10/28/11 had the following intervention written for the mental health associate included "will conduct anger management groups two times per week to help patient develop a plan to gain control of their anger." The posted unit program schedule tilted "Intensive Treatment Services Program Schedule" only lists this group as occurring one time per week, on Tuesdays from 10:00AM to 11:00 AM. The following nursing intervention written on the master treatment plan with no frequency identified "nurse will educate patient and provide material regarding prescribed medication, dosage, frequency, purpose and side effects."

2. Patient D1, admitted 10/31/11, master treatment plan completed 11/2/11listed the following physician interventions with no frequencies included "will observe and assess for suicidality, discuss history and prescribe for depression." The activity therapy interventions listed without frequency included "provide with expressive therapy to encourage patient to start to paint and draw once again." The family therapy/social work interventions listed without frequency included "will work with client, family and current provider to educate and give skills to deal with anxiety and depression."

3. Patient D5, admitted 10/27/11, master treatment plan completed 10/28/11 had the following nursing interventions identified with no frequencies included "nurse will assess for suicide and safety; will assess for symptoms of detox and educate on all medications." The family therapy/social work interventions listed without frequencies included "education on addiction and depression and aftercare for both."

4. Patient D9, admitted 10/27/11, master treatment plan completed 10/28/11had the following physician interventions listed with no frequencies included "will assess for suicidality and depression; prescribe medications for depression and mood and will educate on depression." The nursing interventions listed without frequencies included "will assess for suicidal thoughts/plan and will give client time to share stressors and educate for medications." The family therapist/social work interventions listed without frequencies included "will educate on addiction and depression and set up for psychiatric aftercare for discharge and give information for housing."

5. Patient E2, admitted 10/27/11, master treatment plan completed 10/28/11 had the following nursing interventions listed with no frequencies included "will reinforce substance abuse education and talk one on one about triggers." The following mental health associate interventions were listed without frequencies "will encourage group interaction and socialization" and "will encourage patient to have a more positive attitude to increase their self-worth. The following activity therapy intervention was listed without frequency "will provide opportunities for patient to socialize within activity groups to encourage patients' participation and increase focus/concentration through journaling and structured games and activities."

6. Patient E7, admitted 10/08/11, master treatment plan completed 10/11/11 had the following nursing interventions identified with no frequencies included "nursing will provide one to one interaction with staff to answer questions and provide support for patients' medical issues (Multiple Sclerosis) that contributes to patient's depression."

B. Policy Review

Facility policy #TX1.1 titled "Treatment Planning", (revised 10/2011), section B.b.i.4 states "the following will be identified in the intervention section: the frequency or amount of an intervention." Facility form titled "Multidisciplinary Treatment Plan II" (0021r39/2011) section titled "Multidisciplinary Interventions" defines the following parameters for staff writing interventions: "including type/amount/frequency/duration/purpose."

C. Interviews

1. During an interview with the Director of Nursing and the Chief Executive Officer on 11/2/11 at 11:40AM, they both acknowledged that the master treatment plan for patient D5 "did not have identified frequencies for all listed interventions." In addition, they both verified that the "anger management group" listed with a two time per week frequency on the treatment plan for patient C8 "does not match what is written on the unit schedule." The Director of Nursing stated "I think the staff wrote it that way because they know that the issue of anger is talked about in several other groups."

2. In an interview on 11/03/2011 at 1:30PM, RN 1 stated "I see frequency is not there."

3. In an interview on 11/03/2011 at 1:40PM, SW 1 stated "In my treatment plans I don't write frequencies. I need to start writing frequencies in the treatment plans. I agree it should be there."