HospitalInspections.org

Based on record review, the hospital failed to maintain an monitoring program.

Findings include:

Cross Reference

482.23 (b)(3) Supervision of Nursing Care
482.24 (c)(1) Content of Record: Orders Dated and Signed
482.41 (a) Maintenance of Physical Plant

Based on record review, Registered Nurses failed to supervise and evaluate the level of observation needed to assure that a patient at risk to self and others were protected for ten (10) of the ten (10) sampled patients.

Findings include:

Review of ten (10) medical records revealed:

Patient #1, admitted 2/20/2015 with diagnosis of psychosis. Electronic physician orders failed to contain a observation level order.

Patient #2, admitted 3/10/2015 with diagnosis of depression. Electronic physician orders failed to contain a observation level order. Observation flow sheets failed to indicate patient observation level on 3/12/15 and 3/14/15 7:00 PM- 6:45 AM, 3/17/15 7:00 AM- 6:45 PM, and 3/19/15 7:00 PM- 6:45 AM.

Patient #3, admitted 3/11/15 with diagnosis of substance abuse. Electronic physician orders failed to contain a observation level order. The medical record did not contain Observation flow sheets.

Patient #4, admitted 2/12/15 with diagnosis of psychosis. Electronic physician orders failed to contain a observation level order. Observation flow sheets failed to indicate patient observation levels on 7:00 PM- 6:45 AM shift for dates: 2/21/15, 2/22/15, 2/24/15, 2/26/15, 3/3/15, 3/5/15, and 3/8/15. Documentation on 2/23/15 7:00 AM- 6:45 PM, did not include documentation from 6:00 PM-6:45 PM. Observation documentation was performed every fifteen (15) minutes on all flow sheets.

Patient #5, admitted 2/20/15 with diagnosis of schizophrenia. Electronic physician orders failed to contain a observation level order. Observation documentation was marked as level 3, and performed every fifteen (15) minutes on all flow sheets.

Patient #6, admitted 3/15/15 with diagnosis of psychosis. Electronic physician orders failed to contain a observation level order. Observation documentation was performed every fifteen (15) minutes on all flow sheets, but failed to indicate patient observation level on:
3/17/15 7:00 PM- 6:45 AM
3/18/15 7:00 AM- 6:45 PM
3/19/15 7:00 PM- 6:45 AM
3/20/15 7:00 AM- 6:45 PM
3/22/15, 3/24/15, and 3/26/15 7:00 PM- 6:45 AM

Patient #7, admitted 2/11/15 with diagnosis of psychosis. Electronic physician orders failed to contain a observation level order. Observation flow sheets failed to indicate patient observation levels on 7:00 PM- 6:45 AM shift for dates: 2/11/15, 2/13/15, 2/14/15, 2/15/15, 2/16/15, and 2/20/15. Observation documentation was performed every fifteen (15) minutes on all flow sheets

Patient #8, admitted 2/11/15 with diagnosis of schizophrenia. Electronic physician orders failed to contain a observation level order. Observation flow sheet indicated patient was observation level 3, and documentation was performed every fifteen (15) minutes.

Patient #9, admitted 2/19/15 with diagnosis of dementia. Electronic physician orders failed to contain a observation level order. Observation flow sheets failed to indicate patient observation levels on 7:00 PM- 6:45 AM shift for dates: 2/20/15, 2/25/15, 2/27/15, 2/28/15, 3/1/15, 3/2/15, and 3/4/15. Observation documentation was performed every fifteen (15) minutes on all flow sheets.

Patient #10, admitted 2/13/15 with diagnosis of schizophrenia. Electronic physician orders failed to contain a observation level order . Observation flow sheets failed to indicate patient observation levels on 7:00 PM- 6:45 AM shift for dates: 2/13/15, 2/14/15, 2/15/15, and 2/20/15;
On 2/21/15 no staff initials were documented from 7:45 AM-10:45 AM on the flow sheet
No observation level documented on 2/22/15 7:00 AM- 6:45 PM
Observation documentation was performed every fifteen (15) minutes on all flow sheets.

Review of facility policy titled Patient Classification System for Psychiatry, effective 01/2013, revised 12/17/2014, revealed that patients are placed on one of the following levels on admission and the level is adjusted throughout their stay by the treatment team, which included:
· Level One: staff observes patient's whereabouts on the unit every 30 minutes
· Level two: staff observes patient's whereabouts on the unit every 30 minutes
· Level three (close observation including suicide and violent precautions): staff observes patient's whereabouts on the unit every 15 minutes. This is the standard observation level of all new patients.
· Level four (constant observation, including elopement precautions): patient must be maintained within the visual contact of the staff at all times. Staff documents observation every fifteen minutes.
· Level five (1 on 1): one staff member must maintain the patient with the visual contact at all times, including during sleep. Staff documents observation every fifteen minutes.

Based on medical record review and staff interview, the facility failed to assure that telephone/verbal orders be authenticated promptly by the ordering practitioner for ten (10) of ten (10) patients reviewed (#s 1 - 10).

Findings include:

Patient #1, admitted 2/20/2015 with diagnosis of psychosis. Electronic physician orders failed to include electronic physician signatures with dates and times for 82 of 87 orders entered.

Patient #2, admitted 3/10/2015 with diagnosis of depression. Electronic physician orders failed to include electronic physician signatures with dates and times for 34 of 37 orders entered.

Patient #3, admitted 3/11/15 with diagnosis of substance abuse. Electronic physician orders failed to include electronic physician signatures with dates and times for 24 of 36 orders entered.

Patient #4, admitted 2/12/15 with diagnosis of psychosis. Electronic physician orders failed to include electronic physician signatures with dates and times for 33 of 34 orders entered.

Patient #5, admitted 2/20/15 with diagnosis of schizophrenia. Electronic physician orders failed to include electronic physician signatures with dates and times for 31 of 31 orders entered.

Patient #6, admitted 3/15/15 with diagnosis of psychosis. Electronic physician orders failed to include electronic physician signatures with dates and times for 45 of 45 orders entered.

Patient #7, admitted 2/11/15 with diagnosis of psychosis. Electronic physician orders failed to include electronic physician signatures with dates and times for 24 of 24 orders entered.

Patient #8, admitted 2/11/15 with diagnosis of schizophrenia. Electronic physician orders failed to electronic physician signatures with dates and times for 30 of 32 orders entered.

Patient #9, admitted 2/19/15 with diagnosis of dementia. Electronic physician orders failed to include electronic physician signatures with dates and times for 39 of 43 orders entered.

Patient #10, admitted 2/13/15 with diagnosis of schizophrenia. Electronic physician orders failed to include electronic physician signatures with dates and times for 26 of 27 orders entered.

Interview with Assistant Nurse Manager on 3/27/15 at 3:15 PM in the conference room revealed that the electronic physician orders contained four (4) areas for names/dates/times: the first line is for the person entering the orders; the second line is for person signing order; the third line is for a co-signature; and, the fourth space is for the person who acknowledged the order. The Assistant Nurse Manager acknowledged that a large number of the electronic physician orders had not been electronically signed by the physician, as indicated by "not applicable" entered next to the physician's name on the second line, in the date and time section.

Based on observation and staff interview, the facility failed to maintain the overall hospital environment in a manner that assured the safety and well-being of patients

Findings include:

During a tour on 3/27/2015 at 11:30 AM with the administrator, the following was observed:

Room 111:
Air conditioner vent broken in multiple area

Room 124:
· Air conditioner vent broken in multiple area (4 inch long piece came off in surveyor's hand)
· Shower with rust present
· Two (2), two inch long screws "sitting" at the toilet base, not screwed in

Room 128:
· Missing tile and dirty around base of the toilet
· Damage to floorboard left of shower in restroom
· Sprinkler cover missing

Adult unit, nourishment room (keypad locked, for patient nourishment only):
· Missing threshold tile
· Dirty floor with debris present
· Plastic cooler containing ice, uncovered
· Small refrigerator with black mold around rubber door sealing and in rear. Drinks for patient use inside refrigerator
· Hole in ceiling tile, approximately 12 inches x 4 inches

The administrator acknowledged all above findings during the 3/27/2015 tour.