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Tag No.: C0220
Based on observation, interview, and record review, the facility failed to ensure the fire alarm system components were protected (K-344). The facility failed to ensure fire watch procedures were established for when the fire alarm system was out of service (K-346). The facility failed to ensure fire watch procedures established for when the sprinkler system was out of service (K-354).
Tag No.: C0231
Based on observation, record review and staff interview, the facility failed to meet the requirements for life safety, specifically, the applicable provisions of the 2012 edition of the Life Safety Code of the National Fire Protection Association. This had the potential to affect all patients receiving services from the facility. The facility census was eight.
Findings include:
K-344 - The facility failed to ensure the fire alarm system components were protected.
K-346 - The facility failed to ensure fire watch procedures were established for when the fire alarm system was out of service.
K-354 - The facility failed to ensure fire watch procedures established for when the sprinkler system was out of service (K-354).
Tag No.: C0271
Based on medical record review, staff interview and policy review, the facility failed to adhere to policy and procedures for patients in restraints and psychiatric emergencies for two of four patients reviewed who presented to the emergency department for psychiatric services (Patient #8 and #9) and one of three emeregency department patients reviewed with restraints (Patient #12). This had the potential to affect all patients presenting to the emergency department for psychiatric services. The sample size was 23. The active census was 8.
Findings include:
Review of the policy and procedure titled Psychiatric Emergency effective 06/30/17 revealed if a patient is seen by a community behavioral health agency from the county jail, outpatient office visit, or the community behavioral health agency crisis unit who are send to the emergency department for a medical clearance exam will be cleared, dispositioned and either released or transferred to an appropriate inpatient setting. Because there will be no psych assessment in the record for this particular group of patients (already completed prior to being sent to the emergency department), the emergency room should document in the chief complaint to say, "referral for medical clearance after psych consult performed." Staff A confirmed in an interview on 12/12/19 at 10:32 AM the psychiatric assessments were being completed after the patient presented to the emergency department after being medically cleared.
1). Review of the medical record for Patient #8 revealed the patient presented to the emergency department on 10/20/19 from a local corrections facility accompanied by an officer. The patient was found lying on the floor with a bra wrapped around the neck in the corrections facility and was being evaluated for medical clearance. The emergency room documentation noted intentional self-harm by hanging/strangulation. The patient was discharged back to the correctional facility on 10/20/19 and the patient was to be placed on suicide precautions with increased monitoring.
Staff B stated in an interview on 12/12/19 at 3:39 PM the correctional facility and/or contracted community mobile psychiatric crisis unit completed the psychiatric evaluation. These psychiatric evaluations would not be found in the emergency department medical record. Staff B provided a psychiatric evaluation the following morning after requesting the documentation from the crisis mobile unit. The medical record initially lacked evidence a psychiatric evaluation was completed prior to discharging the patient from the emergency department to ensure safety.
2). Review of the medical record for Patient #9 revealed the patient had a history of suicide attempts and was transported from home by the local police for a psychiatric evaluation on 11/25/19. The patient had self-inflicted stab wounds to the upper chest and left arm. The patient was discharged and transported by local law enforcement to the county jail on 11/25/19.
Staff B stated in an interview on 12/12/19 at 3:39 PM the correctional facility and/or contracted community mobile psychiatric crisis unit completes the psychiatric evaluation. These psychiatric evaluations will not be found in the emergency department medical record. Staff B provided a psychiatric evaluation the following morning after requesting the documentation from the crisis mobile unit. The medical record initially lacked evidence a psychiatric evaluation was completed prior to discharging the patient from the emergency department to ensure safety.
3). Review of the policy titled, Seclusion and Restraints Policy, effective 02/02/19, revealed once restraints are discontinued, the registered nurse shall document the time of discontinuation and the patient's condition.
Review of the medical record for Patient #12 revealed the patient was transported to the emergency department by squad on 10/06/19 due to an altered mental status. The patient was uncooperative and had loss of movement to the left arm/leg. Review of the physican orders revealed the patient was placed in soft restraints to the right upper limb and the right lower limb on 10/06/19 at 6:30 AM. The patient was diagnosed with a stroke, septic shock, and acute renal injury and transferred to the intensive care unit. The medical record lacked evidence of when the patient was released from restraints as per policy.
This finding was confirmed with Staff B in an interview on 12/12/19 at 10:42 AM.
Tag No.: C0298
Based on medical record review and staff interview, the facility failed to develop a care plan for each patient that was complete and current for two of 23 medical records reviewed (Patient #22 and #15). The facility census was 8.
Findings include:
1). Review of the medical record for Patient #22 revealed an admission date of 10/28/19. The patient had diagnoses of sepsis secondary to bladder infection and chronic respiratory failure requiring oxygen use. The medical record documented the patient had a Foley catheter placed (tube inserted into the bladder to drain urine) and was started on continuous oxygen while in the hospital. The nursing care plan failed to identify the need for care and/or interventions for a Foley catheter or oxygen use. In addition, the care plan listed knowledge deficit related to disease process, but lacked any interventions or goals. This was confirmed in an interview with Staff D on 12/12/19 at 11:34 AM.
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2). Review of the medical record for Patient #15 revealed admission to a swing bed on 05/28/19 following a hospitalization at the main hospital campus for respiratory failure. During the hospitalization the patient required mechanical ventilation and was in the intensive care unit. The patient had multiple comorbidities to include metastatic lung cancer and a poor prognosis. Upon admission to the swing bed the nurse completed the assessment and identified an open wound to the coccyx. The physician orders dated 05/28/19 included to turn and reposition the patient as per protocol along with a wound nurse consult. Review of the nursing care plan failed to identify the need for care and/or interventions for a wound. This finding was confirmed in an interview with Staff D on 12/12/19 at 11:34 AM.