HospitalInspections.org

Based on review of 10 medical records and an interview with the Medical Director of Psychiatry it was determined that the hospital failed to ensure that a patient had the right to refuse treatment and/or medication administration.

Patient #9 was a middle-aged female who was seen in the Emergency Department for suicide ideation. An order was written for Benadryl tablet by mouth (PO) 50 mg, once every 6 hours as needed (PRN) for agitation OR Benadryl 50 mg intramuscular (IM) PRN every 6 hours for agitation if unable to tolerate PO. Haldol and Ativan were also written PRN for agitation as PO or IM if unable to tolerate PO.

An interview with the Medical Director of Psychiatry, revealed that "standing orders for these medications are NOT allowed in the inpatient psychiatric unit." The Medical Director of Psychiatry also could not state if it was standard practice in the Emergency Department (ED) psychiatric holding area to write for PO or IM (same drug) as a standing order as needed for agitation. Inconsistencies in medication administration orders between the psychiatric inpatient unit and the Emergency Department psychiatric patient holding area were verified in this interview.

Failure to write and follow orders with specific indications and the clinical situations in which drug administrations is indicated has the potential to compromise patient safety and/or to achieve the intended therapeutic effect.