HospitalInspections.org

Based on medical record review, review of facility investigation documentation, review of facility policy, and interview, the facility failed to protect from verbal abuse for one patient (#1) of five sampled patients.

The findings included:

Medical record review revealed sampled patient #1 was admitted to the facility on August 4, 2010 with diagnoses including Acute Cholecystitis. Medical record review of a discharge summary dated August 9, 2010, revealed the patient was discharged and included, "...in the hope of doing a cholecystectomy. However, his overall condition was so poor that putting...to sleep would be too risky....sent him into respiratory arrest...transferred to the intensive care unit..."

Review of undated, unsigned facility investigation documentation provided by the facility on November 22, 2010 revealed "...Three separate nurses report the following statements were made by Sgt (sergeant - Security Guard #1)...directed to the patient: '...If you come to my home I'm allowed to have a gun at my house...you'll be in the morgue...out of uniform I can carry a gun.' Nursing supervisor was notified and investigation began. Based on the severity of the threats...as witnessed by the nursing staff it was determined that this was considered verbal abuse..."

Review of facility investigation documentation dated August 5, 2010 and authored by Security Guard #1 revealed "...(patient) then told me, "I will catch you on the street and sneak up and Bap, Bap, Bap!" I then advised...that, "I will leave you laying for the Coroner to pick up..."

Review of the facility's abuse policy revealed "...All patients have the right to be free from verbal, sexual, physical and mental abuse...If there is an allegation that a patient has been...abused, always treat it seriously. Never brush off or ignore such an allegation..."

Interview with Registered Nurse (RN) #1 on November 22, 2010 at 1:42 p.m. in a family consultation room, revealed Security Guard #1 made threatening statements to the patient in the presence of four RNs, neither RN intervened to stop the guard's verbally abusive behavior, and the nurse stated, "Afterward we looked at each other, like that was inappropriate and we discussed whether that was appropriate. I think I said out loud I don't think we want to go there."

Telephone interview with Clinical Lab Assistant #1 on November 23, 2010 at 10:25 a.m. revealed Patient #1, three nurses, a respiratory therapist, two security guards, and Clinical Lab Assistant #2 were in the patient's room in the intensive care unit on August 5, 2010. Continued interview revealed,"... The more aggravated (the) patient got...They (Security Guard #1 and patient) then started to exchange words...consider what I saw abusive. (Patient #1)...a small (patient)...just woke up from code...still out of (patient's) mind...Don't remember anyone asking guard to leave. (There were) still two security guards (#1 and #2) and three nurses in room when I left..."

Telephone interview with Security Guard #1 on November 29, 2010 at 10:45 a.m. verified the investigation documentation signed by him and dated August 5, 2010 was correct.

Telephone interview with the facility's risk manager on December 15, 2010 at 1:00 p.m. confirmed the facility had failed to protect Patient #1 from verbal abuse.

C/O: #26556

Based on medical record review, review of facility investigation documentation, review of facility policy, and interview, the facility failed to implement the abuse policy for one patient (#1) of five sampled patients.

The findings included:

Medical record review revealed Patient #1 was admitted to the facility on August 4, 2010, with diagnoses including Cholecystitis, and discharged August 9, 2010.

Review of undated, unsigned facility investigation documentation provided by the facility on November 22, 2010 revealed "...Summary of Reportable Event 08/05/10...Three separate nurses report the following statements were made by Sgt (Sergeant- Security Guard #1)...directed to the patient: '...If you come to my home I'm allowed to have a gun at my house...you'll be in the morgue...out of uniform I can carry a gun.' Nursing supervisor was notified and investigation began. Based on the severity of the threats...as witnessed by the nursing staff it was determined that this was considered verbal abuse..."

Review of facility investigation documentation dated August 5, 2010 and authored by Security Guard #1 revealed "...(patient) then told me, "I will catch you on the street and sneak up and Bap, Bap, Bap!" I then advised (patient) that, "I will leave you laying for the Coroner to pick up..."

Review of the facility's Abuse Policy Number: LDR.RM.006 revealed "...All patients have the right to be free from verbal, sexual, physical and mental abuse...If there is an allegation that a patient has been...abused, always treat it seriously. Never brush off or ignore such an allegation...must be reported to the Department (Tennessee Department of Health) within seven business days from the date that the facility identifies the incident..."

Review of facility documentation dated August 16, 2010 revealed the abuse was not reported to the state agency within seven business days.

Interview with Registered Nurse (RN) #1 on November 22, 2010 at 1:42 p.m. in a family consultation room, revealed Security Guard #1 made threatening statements to the patient in the presence of four RNs, neither RN intervened to stop the guard's verbally abusive behavior, and the nurse stated, "Afterward we looked at each other, like that was inappropriate and we discussed whether that was appropriate. I think I said out loud I don't think we want to go there."

Telephone interview with Security Guard #1 on November 29, 2010 at 10:45 a.m. verified his investigation documentation dated August 5, 2010 was correct.

Telephone interview with the facility's risk manager on December 15, 2010 at 1:00 p.m. confirmed the facility failed to implement the abuse policy for Patient #1.

C/O: #26556