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2100 N MARTIN LUTHER KING, JR, BLVD

CLOVIS, NM 88101

PATIENT RIGHTS

Tag No.: A0115

Based on observation, interview, and record review, the hospital failed to:

1. to provide consents and notice of rights in 10 of 10 (P#1 through #10) patient records sampled in the Emergency Department (ED). This deficient practice prevented patients from understanding their rights and prevents them from filing grievance or complaints.(refer to A116)

2. to allow Patient #1 (P1) to exercise his right to refuse to have an indwelling uror Foley urinary catheter inserted when presenting to the Emergency Department (ED) due to overdose. This deficient practice caused pain, problems urinating and emotional distress to P1. (refer to A129)

3. to obtain a consent for treatment and a physician's order for placement of an indwelling urinary (Foley) catheter for Patient #1 (P1) when P1 presented with an overdose. P1 refused to have the indwelling urinary catheter inserted while in the Emergency Department (ED). A Foley catheter was inserted into P1 without consent. This failed practice caused physical pain to P1 and did cause emotional distress. (refer to A131)

4. to obtain a physician's order for the insertion of an indwelling urinary catheter yet inserted a urinary catheter in Patient #1 (P1). This deficient practice resulted in P1 having difficulty urinating and pain after the indwelling urinary (Foley) catheter was removed. (refer to A144)

PATIENT RIGHTS: NOTICE OF RIGHTS

Tag No.: A0116

Based on interviews and record review, the hospital failed to provide consents and notice of rights in 10 of 10 (P#1 through #10) patient records sampled in the Emergency Department (ED). This deficient practice prevented patients from understanding their rights and prevents them from filing grievance or complaints. The findings are:

A. On 09/20/17 at 8:11 am Staff #15 (S15) stated that if a patient unable to sign the consent for treatment, a note is placed on record stating "unable to sign due to medical conditions." S15 further stated if the patient is able to sign prior to departure they are asked to sign at that time. S15 also stated that patients receive patient rights. However, patients do not sign acknowledgement that he or she have received them. S15 stated that documentation is entered in patient's chart that he/she received these documents.

B. On 09/20/17 at 9:15 am Staff #1 confirmed during an interview that no consents were found in 10 of 10 (#1 through #10) patient records reviewed.

C. Record review indicated that no consents in 10 of 10 (#1 through #10) patient records reviewed.

D. Record review revealed that no patient rights notices were found in 10 of 10 (#1 through #10) patient records.

PATIENT RIGHTS: EXERCISE OF RIGHTS

Tag No.: A0129

Based on interviews and record review, the hospital failed to allow Patient #1 (P1) to exercise his right to refuse to have an indwelling urinary or Foley catheter inserted when presenting to the Emergency Department (ED) due to overdose. This deficient practice caused pain, problems urinating and emotional distress to P1. The findings are:

A. On 09/19/17 at 11:00 am during an interview, Staff #7 (S7) stated she triaged P1. S7 further stated that P1 was lethargic and she spoke primarily with Emergency Medical Services staff S7 stated she primarily documented medical screening for P1 upon arrival for the triage but does not recall what was documented. P1 was brought to the Emergency Room via ambulance.

B. On 9/19/17 at 10:50 am Staff #6 (S6) stated that when she told P1 she was going to place the catheter, P1 rose from the bed. She then tried to explain why it was necessary. (A urine sample was needed to assess drugs in P1 system.) S6 stated P1 became violent. S6 stated that the indwelling catheter was placed after P1 was in restraints. S6 further stated that she does not recall if it was documented when the indwelling catheter was ordered

C.On 9/19/17 at 10:38 am, Staff #5 (S5) stated that P1 woke up immediately after the indwelling urinary catheter was placed and started swinging at people and P1 was then restrained. S5 stated that the Foley catheter was removed prior to restraint removal because P1 was demanding to have it removed. S5 explained to P1 that the urine was going to be used for labs.

D. On 9/19/17 at 11:10 am Staff #8 (S8) stated that he had to hold the P1 down in order to have the indwelling catheter placed. S8 stated soft wrist restraints were used and S8 held the patient's shoulders down. Staff #8 stated that P1 became more aggressive and the patient was alert to the situation. S8 stated he believes that the Foley was placed to prevent the patient from peeing on himself but does not know the real reason.

E. On 9/19/17 at 1:30 pm Staff #13 (S13) stated P1 "came alive" and started to fight the staff when staff started to place the indwelling catheter. S13 stated that she received a call that P1 was combative with staff on the medical floor. S13 stated that P1 complained about not being able to pee due to the catheter placement in ED. S13 then stated that P1 was swearing at her and was upset about the catheter.

F. On 9/19/17 at 10:15 am, Staff #3 (S3) stated that P1 was upset because of the Foley catheter placement. S3 stated that she does not know why P1 had one placed. S3 stated that P1 told the Emergency Department Doctor that he had an enlarged prostate. She further stated that the patient refused the catheter.

G. Record review of P1's chart revealed no orders for the indwelling or Foley catheter placement. Record further reveals that P1 arrived at 9:01 pm. P1 had Foley catheter placed at 9:05 pm and orders were present to remove at 10:00 pm

PATIENT RIGHTS: INFORMED CONSENT

Tag No.: A0131

Based on record review, interview, and observation, the facility failed to obtain a consent for treatment and a physician's order for placement of an indwelling urinary (Foley) catheter for Patient #1 (P1) when P1 presented with an overdose. P1 refused to have the indwelling urinary catheter inserted while in the Emergency Department (ED). A Foley catheter was inserted into P1 without consent.

This failed practice caused physical pain to P1 and did cause emotional distress.

The findings are:

A. On 09/19/17 at 11:00 am during an interview, Staff #7 (S7) stated she triaged P1. S7 further stated that P1 was lethargic and she spoke primarily with Emergency Medical Services staff S7 stated she primarily documented medical screening for P1 upon arrival for the triage but does not recall what was documented. P1 was transfered from ED to Medical Floor then discharged.

B. On 9/19/17 at 10:50 am during interview, Staff #6 (S6) stated that when she told P1 she was going to place the catheter, P1 rose from the bed. She then tried to explain why it was necessary. S6 stated P1 became violent. S6 stated that the indwelling catheter was placed after P1 was in restraints. S6 further stated that she does not recall if it was documented when the indwelling catheter was ordered

C. On 9/19/17 at 10:38 am during interview, Staff #5 (S5) stated that P1 woke up immediately after the indwelling urinary catheter was placed and started swinging at people and P1 was then restrained. S5 stated that the Foley catheter was removed prior to restraint removal because P1 was demanding to have it removed. S5 explained to P1 that the urine was going to be used for labs.

D. On 9/19/17 at 11:10 am Staff #8 (S8) stated that he had to hold the P1 down in order to have the indwelling catheter placed. S8 stated soft wrist restraints were used and S8 held the patient's shoulders down. Staff #8 stated that P1 became more aggressive and the patient was alert to the situation. S8 stated he believes that the Foley was placed to prevent the patient from peeing on himself but does not know the real reason.

E. On 9/19/17 at 1:30 pm Staff #13 (S13) stated P1 "came alive" and started to fight the staff when staff started to place the indwelling catheter. S13 stated that she received a call that P1 was combative with staff on the medical floor. S13 stated that P1 complained about not being able to pee due to the catheter placement in ED. S13 then stated that P1 was swearing at her and was upset about the catheter.

F. On 9/19/17 at 10:15 am, Staff #3 (S3) stated that P1 was upset because of the Foley catheter placement. S3 stated that she does not know why P1 had one placed. S3 stated that P1 told the Emergency Department Doctor that he had an enlarged prostate. She further stated that the patient refused the catheter.

G. Record review of P1's chart revealed no orders for the indwelling or Foley catheter placement. Record further reveals that P1 arrived at 9:01 pm. P1 had Foley catheter placed at 9:05 pm and orders were present to remove at 10:00 pm

PATIENT RIGHTS: CARE IN SAFE SETTING

Tag No.: A0144

Based on record review and interviews, the hospital failed to obtain a physician's order for the insertion of an indwelling urinary catheter yet inserted a urinary catheter in Patient #1 (P1). This deficient practice resulted in P1's rights violation and having difficulty urinating and pain after the indwelling urinary (Foley) catheter was removed. The findings are:

A. On 7/19/17 at 10:15 am during an interview, Staff #3 (S3) stated that Patient #1 (P1) was upset, because of the indwelling urinary or Foley catheter placement. S3 stated that she does not know why P1 had one placed. S3 stated that P1 told the Emergency Department Doctor that he had an enlarged prostate. She further stated that the P1 refused the placement of the catheter. Urine analysis can reveal drugs in the patient's system and is obtained by insertion of a catheter. P1 was transferred from ED to Medical Floor then discharged.

B. On 9/19/17 at 10:38 am during an interview, Staff #5 (S5) stated that P1 woke up immediately after the Foley catheter was placed and started swinging at people. P1 was then restrained. S5 stated that the Foley catheter was removed prior to restraint removal because P1 was demanding to have it removed. S5 explained to P1 that the urine was going to be used for labs because P1 presented at the ED for overdose.

C. On 9/19/17 at 10:50 am Staff #6 (S6) stated that when she told P1 she was going to place Foley catheter, P1 rose from bed. She then tried to explain why it was necessary. S6 stated P1 became violent. S6 stated that the Foley catheter was placed after P1 was in restraints because of P1's violent behavior. S6 further stated that she does not recall if it was documented when the Foley catheter was ordered.

D. On 9/19/17 at 11:10 am during an interview, Staff #8 (S8) stated that he had to hold P1 down because of P1's violent behavior in order to have Foley catheter placed. S8 stated soft wrist restraints were used and S8 held the patient's shoulders down. S8 stated that P1 became more aggressive and the patient was alert to the situation. S8 stated he believes that the Foley was placed to prevent patient from peeing on himself but does not know the real reason.

E. On 9/19/17 at 1:30 pm during an interview, Staff #13 (S13) stated P1 "came alive" and started to fight the staff, when staff started to place Foley Catheter. S13 stated that she received a call that P1 was combative with staff on the medical floor. S13 stated that P1 complained about not being able to pee due to the catheter placement. S13 then stated that P1 was swearing at her and was upset about the catheter.

F. Record review of P1's chart revealed no orders (verbal or written) for Foley catheter placement.