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Based on record review and interview, the facility failed to ensure they followed their own grievance policy and procedure for two of five (#1 and #2) sample patients. Failure to follow your own policy and procedures for investigating grievances may result in the patients not understanding or feeling their concerns were not taken seriously.
Findings:

1. Review of the Patient Rights and Responsibilities policy and procedure revealed it became effective 12/01/07 and was last reviewed on 12/01/08. Further review of this policy and procedure revealed the patient is entitled to, " Considerate and respectful care, provided in safe environment, free from all [form] of abuse or harassment. Be advised of the hospital grievance process, should he/she wish to communicate a concern regarding the quality of care he she receives or if he/she feels determined discharge date is premature. Notification of the grievance process includes: whom to contact to file a grievance, and that he or she will be provided with a written notice of the grievance determination that contains the name of the hospital contact person, the steps taken on his or her behalf to investigate the grievance, the result of the grievance and the completion date. "

2. Review of the Patient Complaint Resolution/Management/Grievance Procedure revealed an effective date of September 1993 and a revision date of May 2009. According to the Procedure section of this policy revealed the procedures to be, " 1. Staff present, who initially receive the concern or complaint, shall attempt to resolve the issue immediately. " Staff present " includes any hospital staff present at the time of the complaint or who can quickly be at the patient ' s location (i.e. nursing, administration nursing supervisors, patient advocates, etc.) to resolve the patient ' s complaint. However, if the complaint is a serious Quality of Care or Legal Concern, staff should enter event into RiskMaster. 2. A letter of acknowledgement will be sent to the patient/representative within 7 days, unless issue can be resolved immediately. 3. Risk Management will determine type of complaint and refer to appropriate department as necessary. 4. Turnaround time for review of complaint and feedback to Risk Management by departments is 5 business days. 5. Risk Management will send letter to author of complain/grievance within 45 days or original complaint. Resolution will be documented in RiskMaster. 6. Florida Hospital Waterman has an ad hoc grievance committee that meets when needed to resolve a particular grievance. The committee members will be determined by Professional Services on a case by case basis. "

3. Review of the facility ' s grievance log revealed that patient #1 ' s family member filed a complaint regarding a floating nurse and a PCT who were unkind to the patient, when ever he/she pushed the call bell. The nurse was accused of being unkind and the PCT had " a bad attitude " . According to the grievance log, the President of the hospital ' s Foundation received the call, two managers were informed of the complaint, and the issue was resolved. According to the " Notes, " section of this log, " After meeting with the family and addressing the staff, [named Nurse Manager] called [President ' s name] back. [President] followed up with flowers on 2/2/1- to the room and a personal visit with the family on 2/3/10. [The] family seems pleased with the changes. [President] called the [parent] on 2/5/10 to make sure all was still fine and the patient, [named] had been discharged. Family seemed pleased with the recovery efforts and indicated they would write a letter. "

Interview with the President of the Foundation on 4/14/10 at 3:15 PM revealed she received the call and informed the Nurse Manager who investigated if the situation occurred. She is aware that the patient ' s nurse was removed from the patient ' s care. According to the President, the patient received flowers as the family is long standing member of the community, so the flowers were given as a sign of good gesture.

Interview with the writer (Unit Nurse Manager) of the above information on 4/14/10 at 3:25 PM revealed he had not written anything regarding this complaint down. According to the Unit Nurse Manager, when the President contacted him regarding the complaint, he spoke to patient #1 ' s parents and then to the PCT, who worked on his floor. The Unit Nurse Manager then stated that he referred the concerns regarding the nurse to her supervisor, as the nurse had been floated to his floor for the day. Further interview revealed that he removed the PCT from providing care to patient #1, even though the PCT denied the allegation. When asked what other investigation was conducted to determine the validity of the complaint, the Unit Nurse Manger stated that all he did was remove the PCT from the patient ' s care and refer the nurse to her supervisor.

Interview with the Risk Manager on 4/14/10 at 3:30 PM revealed the nurse ' s supervisor is no longer employed at the facility and no documentation has been found regarding her investigation in to the allegation.

4. On 4/14/10 at 2:40 PM the Risk Manager and the Director Critical and Clinical Information informed that they have been investigating a grievance filed by Patient #2 ' s spouse. According to the interview, the patient and his/her spouse stated that the patient did not receive his/her seizure medication and that a short, African American, woman with pig tails shoved patient #2 in to the door frame and blocked his/her way out of the room. The patient and spouse thought that they had been rushed through the Emergency Room, but the main concerns were the medication issue and the staff member who shoved the patient. According to the Director, she looked in to the concerns by first looking through patient #2 ' s record and found that the patient received his/her seizure medications everyday while at the hospital. She also was able to determine that at some point of the patient ' s stay, the patient became confused and combative. According to the Director, when the patient became confused and combative, he/she accused a staff member of throwing a telephone at him/her. The patient also accused the spouse of verbal abuse and stealing his/her money. The Director further stated that the patient ' s spouse did not stay in the hospital during the night and that he/she had not witnessed any abuse of the patient. The Director further stated that they pooled all of the staff that worked on the floor, during patient #2 ' s stay, and were not able to identify anyone who fit the description the patient provided. According to the Director, patient #2 stated that this abusive staff member also took him/her to have a procedure done. The Director did find that the patient had a procedure conducted, but was not taken to the procedure by any of the floor staff as they have people on staff who are assigned just to transferring patients to procedures and then back to the floor. The patient and the spouse met with the Director and then with the Chief Executive Officer (CEO) and the Chief Operations Officer (COO). After the meeting with the CEO and COO, patient #2 and the spouse did not ask for any other follow-up to be conducted, but patient #2 stated he/she did not want to return to the hospital.

Review of patient #2 ' s medical record revealed the patient was admitted to the hospital on 3/12/10 with a chief complaint of abdominal pain and rectal bleeding. Further review of patient #2 ' s record revealed that the patient received the medications as prescribed by the physician. Review of patient #2 ' s electronic medication administration record (EMAR) revealed the patient received Lamotigine 25 milligrams (mg) on 3/13/10, 3/14/10, 3/15/10 and 3/16/10. Further review of the EMAR revealed the patient also received Levetiracetam (Keppra) 500 mg, 2 tablets on 3/13/10 at 9:00 (9:00 AM) and 21:00 (9:00 PM). Patient #2 also received Levetiracetam 500 mg, 1 tablet on 4/14/10 at 21:00, 3/15/10 at 9:00, and 21:00 and on 3/16/10 at 9:00. All of these medications are used to treat seizure disorders.
Review of patient #2 ' s record also revealed a, " Special Charting, " documentation dated 3/13/10 which indicated that the patients spouse was called as the patient ' s anxiety increased and he/she yelled for the staff to get out of the room and stating he/she would do the facility ' s laundry. Another Special Charting documentation dated 3/14/10 at 23:00 (11:00 PM) states, " [patient] very confused and paranoid, getting out of bed and tried to run away from the room, patient states that [he/she] is trying to call [his/her spouse] since 1 hour, offered the [patient] to call the [spouse] stated that [he/she] will call the police if needed, talked to come " . Further review of patient #2 ' s record revealed a Short Rounds Report signed on 3/14/10 which has a hand written note regarding a case manager concern. Review of this notation revealed, " Case [Manger] reports issue of possible verbal/[psychological] abuse - ? Paranoid Nurse reports [spouse] is making decisions for [him/her] and declines some [medications] and brought new [medication] list. " The patient ' s record also contains an entry dated 3/14/10 which request for a psychiatry consult. A stamp entry below this request indicated that the consult was requested on 3/14/10 at 1445 (2:45 PM) with a hand written notation that a message was left on the, " cell phone " .
Further review of the patient ' s record revealed that upon admission in to the facility, the patient received a documentation entitled, " AN IMPORTANT MESSAGE FROM MEDICARE ABOUT YOUR RIGHTS " . Review of this documentation revealed it spoke of all of the patient ' s rights regarding admission and treatment.

Review of the electronic mail (e-mail) correspondence between the multiple hospital staff, regarding patient #2 ' s grievance revealed correspondence on this grievance initiated on March 25, 2010 at 12:52 PM from the Executive Assistant to the Vise President and Chief Nursing Officer. According to the e-mail, the writer received a call from patient #2 ' s spouse indicating that he/she wanted to speak to the hospital ' s Administrator regarding a complaint, but he/she would not tell the writer what the concerns were. The spouse indicated that he/she tried to contact a named individual, but never received a response from that individual, so now they wish to speak to the Administrator. The correspondence was initially addressed to the Director Critical and Clinical Information.

Review of the Director Critical and Clinical Information ' s response revealed the correspondence was also answered via e-mail on March 25, 2010 at 1:39 PM. According to this e-mail, the writer spoke to the patient and his/her spouse and the patient was very emotional during the conversation. The patient ' s spouse admitted that he/she never left a message for the named individual, in order to receive a response. According to the e-mail, the writer was given the patient ' s and spouse ' s concerns and will be going through the patient ' s record and following up with the named individual, the Nurse Manager.

A response from the Nurse Manager revealed she responded, via e-mail, on March 25, 2010 at 3:41 PM. According to the e-mail, " In reviewing the caregivers, [patient #2] had some of the most competent and caring nurses from the unit. I consistently have compliments from patients regarding their care. In speaking with the Charge Nurse from days on March 15th and 16th; [patient #2] had some periods of confusion with some behavior that was unusual and at one point [the spouse] was called to speak with [the patient] but was very nice and no concerns were raised at that time on the day of discharge. "

The Director Critical and Clinical Information responded, via e-mail on March 25, 2010 at 4:49 PM revealed that she contacted the patient and the patient ' s spouse and they felt that they could only have their concerns resolved by meeting face-to-face with the hospital ' s Administrator. The patient and the patient ' s spouse refused a meeting with the nursing leadership. Further review of the e-mail revealed, " [His/Her] two top concerns were ...1. Stated that [his/her spouse] did not receive [his/her] anti-seizure medication ...according to the MAR [he/she] did receive them beginning the first morning of [his/her] admission 2. Staff was rough with [him/her], the [spouse] did not witness, happened during the night ... there is documentation of [patient] becoming combative, confused, and at one point throwing a phone at a nurse (I did share this with the patient and the patient ' s spouse). " According to the e-mail, the patient and the patient ' s spouse were informed how to request a copy of the patient ' s medical record.

Another e-mail dated March 30, 2010 at 9:08 AM revealed the writer was the Professional Service person who indicated that patient #2 ' s spouse contacted her to request a meeting with the Administrator. The spouse did not wish to have the writer assist him/her and only requested to meet with the Administrator.

A response to this e-mail from the Senior Vice President/COO on March 30, 2010 at 9:09 AM revealed that they were setting up an appointment with the Director Critical and Clinical Information, the Administrator and himself for that week.

Another e-mail received on March 30, 2010 at 9:17 AM confirmed the COO ' s e-mail, indicating that the meeting would be that Thursday at 12 noon.

Another e-mail dated March 30, 2010 at 9:39 AM, addressed to the Nurse Manager revealed that the writer was spoken to by a named individual regarding the patient ' s complaint from several weeks ago. According to the e-mail, " The patient was paranoid and anxious. I switched nurses and she was more paranoid with Diane. I ultimately took over for a while, until [the patient ' s spouse] could get here. [The patient] was convinced that [the spouse] was out ' with [another person] and all of us were conspiring against [him/her]. [The patient] fabricated some things as well as misinterpreting others. Gaya moved [the patient ' s] bedside table, accidentally dropping the telephone, which later escalated into [the patient] telling everyone that she had thrown it at [him/her]. (That is when I had Gaya trade with Diane, and then eventually me, until ultimately [the patient] wanted Gaya again!) " Further interview of this e-mail revealed, " [The spouse] apologized for [the patient ' s] behavior, bringing us doughnuts etc, but still thought it was ' something you are giving [him/her] ' that was making [him/her] paranoid. I went over [the patient ' s medication] list with [him/her] and [the patient] had received nothing new at that time and [his/her] labs were ok. We did eventually give [him/her] a half dose of Dilaudid at [the spouse ' s] insistence because [he/she] was so upset and miserable from the bowel [preparation]. "

Interview with the Nurse Manager on 4/15/10 at 9:40 AM revealed she was informed that the patient and the patient ' s spouse had attempted to contact her, but she never received a call from either of them. Further interview revealed that when she was informed of the allegations, she looked in to the care givers and looked at the Charge Nurse ' s reports for those days and was only able to find documentation regarding the patient ' s behavior. Further interview revealed that when she looked in to the allegation that the staff threw a telephone at the patient revealed that the staff would not allow the patient to bend and pick the telephone off the floor. According to the Nurse Manager, the staff was afraid that the patient would fall over, while bending. The staff then picked the telephone off the floor and it was at this time that the patient accused the staff of throwing the telephone at him/her.


Interview with the Risk Manager on 4/14/10 at 3:30 PM revealed that patient #1 did not receive a letter at the end of the resolution. It was identified that at the time of the survey, it had been 52 days since the patients grievance was resolved. Further interview revealed that patient #2 did not receive a letter with in 7 days of receipt of the grievance.