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Based on review of facility policies and procedures, review of medical records (MR), and interview with staff (EMP), it was determined the facility failed to ensure that patients had the right to formulate advanced directives for three (3) of ten (10) patients rights medical records reviewed (MR17, MR25, and MR26).

Findings include:

Review on January 23, 2018, of the facility policy, "Patients' Rights and Responsibilities", dated, "9/15/15", revealed " ... Patient's Rights ... The right to have an advanced directive, such as a living will or durable power of attorney for health care ...

Review on January 23, 2018, of the facility policy, "Advance Directives/Living Will and/or Durable Power of Attorney", dated, "9/15/15", revealed "Policy In compliance with the Patient Self Determination Act and Pennsylvania State Law, it is the policy of Abington Memorial Hospital to ascertain whether or not adult patients being admitted have an Advance Directive ... Procedure 1. As part of the nurse's admission assessment, she/he will determine whether or not admitted patients have an Advanced Directive ... The nurse will document this in the Admission Data Base ... "

Review on January 23, 2018, of MR17, revealed the patient was admitted to the facility on January 10, 2018. Further review of MR17 revealed no documented evidence that the nursing admission assessment determined whether or not the patient had an advanced directive or required assistance formulating an advance directive.

Review on January 23, 2018, of MR25, revealed the patient was admitted to the facility on January 20, 2018. Further review of MR25 revealed no documented evidence that the nursing admission assessment determined whether or not the patient had an advanced directive or required assistance formulating an advance directive.

Review on January 23, 2018, of MR26, revealed the patient was admitted to the facility on January 21, 2018. Further review of MR26 revealed no documented evidence that the nursing admission assessment determined whether or not the patient had an advanced directive or required assistance formulating an advance directive.

Interview with EMP13, on January 23, 2018, between approximately 12:50 P.M. and 14:15 P.M., confirmed that MR17, MR25, and MR 26 "did not" contain documented evidence that the patient's advance directive information was obtained on admission to the facility.

Based on a review of facility policies and procedures, review of medical records (MR), and interview with staff (EMP), it was determined that the facility failed to promptly notify a physician of the patients' choice, of his or her admission to the hospital, for four (4) of ten (10) patients rights medical records reviewed (MR19, MR23, MR25 and MR26).

Findings include:

Review on January 23, 2018, of the facility policy, "Patients' Rights and Responsibilities", dated, "9/15/15", revealed " ... Patient's Rights ... The right to be informed of rights as a patient as the earliest possible moment in the course of a patient's hospitalization and to have a family member and/or physician of the patient's choice notified of the patient's admission, and to have a family member and/or physician of choice notified of your hospitalization ... "

Review on January 23, 2018, of the facility document, "DOH POS Identification of Patient Representative and Provider of Care ETC/EMR to Admit" instructions for completion, dated, no date provided, revealed "Patient's Representative of choice Notification/Documentation Ask patient if they would like for us to notify someone that they are being admitted ... If patient states yes ... Document in [ER electronic documentation system name] AA Communicate Template ... If patient states no or unable to Obtain ... Document in [ER electronic documentation system name] AA Communicate Template ... Patient's Physician of choice Notification/Documentation Ask patient if they would like for us to notify their provider of choice ... Document in [ER electronic documentation system name] AA Communicate Template ... "

Review on January 23, 2018, of MR19, revealed the patient was admitted to the facility on January 18, 2018. Further review of MR19 revealed no documented evidence that the patients' physician of choice was promptly notified of the patients' admission to the facility.

Review on January 23, 2018, of MR23, revealed the patient was admitted to the facility on January 15, 2018. Further review of MR23 revealed no documented evidence that the patients' physician of choice was promptly notified of the patients' admission to the facility.

Review on January 23, 2018, of MR25, revealed the patient was admitted to the facility on January 20, 2018. Further review of MR25 revealed no documented evidence that the patients' physician of choice was promptly notified of the patients' admission to the facility.

Review on January 23, 2018, of MR26, revealed the patient was admitted to the facility on January 21, 2018. Further review of MR26 revealed no documented evidence that the patients' physician of choice was promptly notified of the patients' admission to the facility.

Interview with EMP13, on January 23, 2018, between approximately 12:50 P.M. and 14:15 P.M., confirmed that MR19, MR23, MR25, and MR26 "did not" contain documented evidence that the patient's respective physician of choice was notified of the patient's admission to the facility.

Based on review of facility policies and procedures, medical records (MR), and interview with staff (EMP), it was determined the facility failed to ensure less restrictive interventions were determined to be ineffective, before the application of mechanical restraints, for four (4) of five (5) restraint medical records reviewed (MR2, MR3, MR4, and MR6).

Findings include:

Review on January 23, 2018, of the facility policy, "Restrain and Seclusion", dated, "1.2018", revealed "I. Policy ... The patient protections contained in this policy apply to all hospital patients when the use of restraint or seclusion becomes necessary regardless of the patient location. Restraint or seclusion is only used after alternatives have been considered and/or determined to be ineffective ... Addendum Alternatives to Restraint Use Alternatives should be individualized to meet patients' needs and should be considered for use, and/or determined to be ineffective ... "

Review on January 23, 2018, of the facility policy, "Patients' Rights and Responsibilities", dated, "9/15/15", revealed "... Patient's Rights ... The right to be free from seclusion and any form of restraint, both physical and drug, that is not medically necessary or is used as means of coercion, discipline, convenience or retaliation by staff ..."

Review on January 23, 2018, of MR2, revealed the patient was being treated in the facilities Emergency Trauma Center on August 10, 2017. Further review of MR2 revealed the patient was placed in mechanical restraints on August 10, 2017. Further review of MR2 revealed no documented evidence that restraint alternatives and/or less restrictive interventions, were determined to be ineffective, prior to the application of mechanical restraints on the patient.

Review on January 23, 2018, of MR3, revealed the patient was being treated in the facilities Emergency Trauma Center on August 14, 2017. Further review of MR3 revealed the patient was placed in mechanical restraints on August 14, 2017. Further review of MR3 revealed no documented evidence that restraint alternatives and/or less restrictive interventions, were determined to be ineffective, prior to the application of mechanical restraints on the patient.

Review on January 23, 2018, of MR4, revealed the patient was being treated in the facilities Emergency Trauma Center on September 4, 2017. Further review of MR4 revealed the patient was placed in mechanical restraints on September 4, 2017. Further review of MR4 revealed no documented evidence that restraint alternatives and/or less restrictive interventions, were determined to be ineffective, prior to the application of mechanical restraints on the patient.

Review on January 23, 2018, of MR6, revealed the patient was being treated in the facilities Emergency Trauma Center on October 14, 2017. Further review of MR6 revealed the patient was placed in mechanical restraints on October 14, 2017. Further review of MR6 revealed no documented evidence that restraint alternatives and/or less restrictive interventions, were determined to be ineffective, prior to the application of mechanical restraints on the patient.

Interview with EMP3 and EMP4, on January 23, 2018, between approximately 11:51 A.M. and 12:47 P.M., confirmed that MR2, MR3, MR4, and MR6 "did not" contain documented evidence that restraint alternatives and/or less restrictive interventions, were determined to be ineffective, prior to the application of mechanical restraints.