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500 BURLINGTON ROAD

JACKSON, OH 45640

No Description Available

Tag No.: C0270

Based on documentation review and staff interview the facility failed to ensure policies and procedures were followed for patients with psychiatric conditions that sign out against medical advice (AMA) before the completion of a psychiatric evaluation. (C271). The cumulative effect of this systemic practice resulted in the facility's inability to ensure the safety of the patients with psychiatric conditions.

No Description Available

Tag No.: C0271

Based on documentation review and staff interview the facility failed to ensure policies and procedures were followed for patients with psychiatric conditions that sign out against medical advice (AMA) before the completion of a psychiatric evaluation. This affected 3 ( Patient #9, #13, and #14) of 12 medical records reviewed with psychiatric evaluation orders. This has the potential to affect all patients receiving services through the facilities emergency room. The facility census was 18.

Findings include:

Review of the policy titled "Patient Leaving Against Medical Advice (AMA)" completed on 03/03/20 revealed under section D. Patients requesting to leave AMA - Emergency Department in bullet 6 it states "If the patient is incapacitated (as determined by a provider) or incompetent (as determined by a court of law) and/or has an order for a psychiatric evaluation, the patient may not sign out AMA. If the patient insists on leaving, the ED provider must determine what measures (persuasion, restraint, etc.) will be taken to prevent the patient from leaving the facility. GPU or other appropriate agency will be notified of the attempted departure. If the patient requires physical and/or chemical restraint the System Seclusion & Restraints policy must be followed, and the least restrictive method of keeping the patient in the ED must be used. This was verified by Staff A on 03/03/20 at 10:08 AM.


1. Review of Patient #9's medical record on 03/03/20 revealed Patient #9 presented to the emergency department with complaint of suicidal ideation on 02/10/20. Patient #9 reported he/she went for a walk in the woods this morning with a gun and thought at that time of harming him/herself. Patient #9 denies suicidal ideation at this time. Patient #9 reports increased depression and anxiety since yesterday related to having to close his/her church. An order for Psychiatric consult when medically cleared was noted on 02/10/20. The ED Physician noted Patient #9 declined a psychiatric evaluation. The record revealed a Leaving Against Medical Advice form was signed by Patient #9 and Patient #9's spouse. No psychiatric evaluation was noted in the medical record.

These findings were verified by Staff A on 03/03/20 at 10:08 AM.


2. Review of Patient #13's medical record completed on 03/03/20 revealed Patient #13 came into the emergency department with complaint of aggressive behavior on 02/17/20. The ED Physician noted Patient #13 had developmental delays and mental retardation (MR). Patient #13 came to the facility due to increasing aggressive behavior and has become quite violent. An order for Psychiatric consult when medically cleared was noted. Patient #13's care taker was permitted to sign a Leaving Against Medical Advice form on 02/17/20. No psychiatric evaluation was noted in the medical record.

These findings were verified by Staff A on 03/03/20 at 10:08 AM.


3. Review of Patient #14's medical record completed on 03/03/20 revealed Patient #14 came into the Emergency department with complaint of suicidal ideation on 02/27/20. The ED Physician noted Patient #14 had been depressed for a long time. Patient #14 saw his/her primary care physician who wrote a prescription for an antidepressant medication. Patient #14 stated that it did not help and he/she stopped taking it a while back. Patient #14 admitted that he/she was more depressed in the past 2 months and that he/she did have "thoughts of killing him/herself". Patient #14's parents stated that they had no suspicion of this. An order for Psychiatric consult when medically cleared was noted. The ED Physician documented that psychiatric services were notified of medical clearance at 2:00 PM. Patient #14 and parents became impatient with waiting for the psychiatric service to arrive and evaluate. They decided to sign out AMA. Patient #14 was allowed to sign an AMA and leave the facility. No psychiatric evaluation was noted in the medical record.

These findings were verified by Staff A on 03/03/20 at 10:08 AM.




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