HospitalInspections.org

Based on record review, staff interview and document review it was revealed the facility failed to follow its own policy and procedure on conducting close constant observation (CCO) for one (1) out of thirty (30) patients (patient #1). This failure places all patients to have their patient rights violated, resulting in harm.

Findings include:

1. A review of patient #1's clinical record revealed the physician wrote orders for CCO on 9/2/19. These orders were still in effect on 9/30/19. A review of patient #1's clinical record revealed the physician did not give orders to limit conversation during the CCO.

2. Interviews with direct care staff from 5 North, conducted separately, revealed five (5) out of five (5) staff interviewed stated patient #1 was on a CCO observation level during the time they cared for patient #1. Interviews with these staff members revealed three (3) out of five (5) believed the procedure for conducting a CCO included not conversing with the patient. Interviews with these staff revealed they were limiting conversation with patients on CCO, including patient #1. One (1) out of two (2) Registered Nurses (RNs) interviewed stated not conversing with a patient on CCO observation level was a hospital-wide policy which she strictly enforced.

Interviews conducted separately with the Director of Patient Services and the Chief Nursing Officer (CNO) revealed it is not a hospital policy to not converse with a patient who is on CCO.

3. A review of document titled "Levels of Observation," reviewed and revised 4/18/19, revealed in part: "Guidelines for implementation of this level of observation include, but are not limited to the following: 1. Individual staff accompaniment including interaction and therapeutic activity with the patient.."

A review of documents outlining training given to staff during orientation and yearly thereafter include policies and procedures for conducting a CCO. A review of personnel records revealed staff are checked off on conducting CCO per this instruction.

A review of document titled "Patient Rights Policy," revised 4/23/19, revealed it states in part: "Any restriction on the patient's rights...must be pursuant to a physician's order and clinically justified for reasons of physical and/or emotional well-being safety, or security."

4. During an interview conducted on 10/30/19 at 10:05 a.m. the CNO concurred with the above findings. She stated not conversing with patients who are on CCO is not a hospital-wide policy and is not acceptable practice.

Based on record review, staff interview and document review it was revealed the facility failed to follow its own policy and procedure on conducting close constant observation (CCO) for one (1) out of thirty (30) patients (patient #1). This failure places all patients to have their patient rights violated, resulting in harm.

Findings include:

1. A review of patient #1's clinical record revealed the physician wrote orders for CCO on 9/2/19. These orders were still in effect on 9/30/19. A review of patient #1's clinical record revealed the physician did not give orders to limit conversation during the CCO.

2. Interviews with direct care staff from 5 North (conducted separately) revealed five (5) out of five (5) staff interviewed stated patient #1 was on a CCO observation level during the time they cared for patient #1. Interviews with these staff members revealed three (3) out of five (5) believed the procedure for conducting a CCO included not conversing with the patient. Interviews with these staff revealed they were limiting conversation with patients on CCO (including patient #1). One (1) out of two (2) Registered Nurses (RN) interviewed stated not conversing with a patient on CCO observation level was a hospital-wide policy which she strictly enforced.

Interviews conducted separately with the Director of Patient Services and the Chief Nursing Officer (CNO) revealed it is not a hospital policy to not converse with a patient who is on CCO.

3. A review of document titled, "Levels of Observation" reviewed and revised 4/18/19 revealed it states in part, "Guidelines for implementation of this level of observation include, but are not limited to the following: 1. Individual staff accompaniment including interaction and therapeutic activity with the patient.."

A review of documents outlining training given to staff during orientation and yearly thereafter include policies and procedures for conducting a CCO. A review of personnel records revealed staff are checked off on conducting CCO per this instruction.

A review of document titled, "Patient Rights Policy" revised 4/23/19 revealed it states in part, "Any restriction on the patient's rights...must be pursuant to a physician's order and clinically justified for reasons of physical and/or emotional well-being safety, or security."

A review of staffing matrix and staffing assignments revealed a Registered Nurse is always on duty and directs all patient care.

4. During an interview conducted on 10/30/19 at 10:05 a.m. the CNO concurred with the above findings. She stated not conversing with patients who are on CCO is not a hospital-wide policy and is not acceptable practice.