HospitalInspections.org

Based on interview and record review the hospital failed to ensure 1 of 5 units PICU (Psychiatric Intensive Care Unit) was adequately staffed based on patient needs from 07/03/14 through 07/07/14.

Findings Included:

(Patient #4's) pre-admission exam dated 06/22/14 timed at 2145 reflected, "Patient has been previously diagnosed with bipolar disorder and is currently in a manic episode...auditory hallucinations and is fixated on Voodo...homicidal ideations towards mother, paranoid and has not slept in three days..."

The physician's orders dated 07/01/14 through 07/07/14 reflected, "Line of sight while awake."

The nursing progress note dated 07/03/14 timed at 1800 reflected, "Patient anxious and pacing the hallways..."

The nursing progress note dated 07/04/14 timed 0700 to 1100 reflected, "Patient exhibiting increased anger...at 1800 remains on LOS (Line of Sight) while awake...patient changes clothes multiple times during the shift wearing inappropriate clothing...she is oppositional and defiant..."

The 07/05/14 nursing progress note timed at 0915 reflected, "Pressured speech, disorganized thoughts, hyperactive, in and out of group..."

The PICU staffing records for 07/03/14 through 07/08/14 reflected the following:

1) The staffing for 7 AM to 3 PM on 07/03/14 reflected, 1 RN and 1 MHT for 12 patients and one LOS (line of sight) for (Patient #4).

2) The staffing for 7 AM to 3 PM on 07/04/14 reflected, 1 RN and 1 MHT for 14 patients, and one LOS for (Patient #4).

3) The staffing for 7 AM to 7 PM on 07/05/14 reflected, 1 RN and 1 MHT for 13 patients, and one LOS for (Patient #4). Eight of the 13 patients were on suicide precautions, 5 of the 13 were on fall precautions and three patients were on aggression precautions.

4) The staffing for 7 AM to 7 PM on 07/06/14 reflected, 2 nurses and 1 MHT for 17 patients and one LOS for (Patient #4). Nine of the 17 patients were on suicide precautions, 6 on fall precautions, 3 on aggression precautions and three admissions.

5) The staffing for 7 AM to 3 PM on 07/07/14 reflected, 2 nurses, 2 MHT's for 20 patients and one LOS for (Patient #4). Nine of the 20 patients were on suicide precautions, seven on aggression precautions and two on fall precautions.

6) The staffing for 3 PM to 11 PM on 07/08/14 reflected, 1 RN, 1 LVN and 1 MHT for 19 patients. The unit had two discharges and two admissions. Thirteen of the 19 patients were medically compromised, seven falls and four on aggression precautions.

On 07/08/14 at 2225 Personnel #7 stated the staffing on the PICU Unit was not adequate for the acuity of the patients and the number of nurses and technicians. Personnel #7 stated the current unit census was 19 patients with one LVN (Licensed Vocational Nurse), one RN (Registered Nurse) and one MHT (mental health technician).

On 07/08/14 at 2245 Personnel #11 was interviewed. Personnel #11 stated he makes rounds on 19 patients. Personnel #11 stated the nursing staff are busy passing medications, charting, answering the phone, discharging and admitting patients. Personnel #11 indicated the staffing on the PICU Unit was not adequate for the acuity of the patients. Personnel #11 stated at times one technician was responsible for 15 minute rounds and LOS observation at the same time.

On 07/09/14 at 1330 (Patient #8) was interviewed on the PICU Unit. (Patient #8) stated there was not enough staff on the unit. (Patient #8) stated patients have to wait for the staff and there are times the staff do not check on the patients every fifteen minutes. (Patient #8) stated the nurses are so busy in the office doing paperwork and medications they spend minimal time with the patients. (Patient #8) stated there are times she did not feel safe.

The Nursing Plan of Care for 2014 reflected, "Scheduling and program assignment of nursing personnel is anticipated and based on the identified needs of the patient population...make appropriate adjustment in the number and blend of nursing care personnel to ensure delivery of care...variables considered in staffing...level of patient assessment, level of assessment required, census, input from nursing staff members...patient responses to treatment..."

The policy and procedure entitled, "Level of Observation/Hand-off Communication" with a revision date of 05/13 reflected, "Any patient placed on an advanced level of observation...line of sight...patient remains within visual eyesight of staff...patient's bedroom door will remain locked, when not in use, when patient changes, showers, uses bathroom, the staff will keep the patient within line of sight at all times...the safety of the patient must be the main consideration..."