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Based on record review and interview, the hospital failed to ensure that the exercise of Patient's Rights requirement was met. This deficiency is evidenced by failure of the hospital to provide the patient representative with treatment options, risks, and benefits through treatment plan review and asked to sign the treatment plan following a change in patient condition for 1 (#1) of 5 (#1-5) records reviewed.
Findings:

Review of hospital policy titled "Informed Consent, Care Decisions and Conflicts Resolution; Patient Rights" revealed, in part: Care Decisions and Conflict Resolution. 1. The therapist or nurse, as applicable, will ensure the following occurs during the patient's stay: Obtaining patient signature and acknowledgement of master plan of informed treatment options. 4. Should a patient already have a legal representative, that representative will give informed consent for care, treatment, and services decisions. The responsible representative will be provided with treatment options, risks, and benefits through treatment plan review and asked to sign the treatment plan.

Review of Patient #1's medical record revealed that on 03/12/2023 at 4:20 p.m. patient was having his brief changed in bathroom. Noted was that Patient #1 was kicking and trying to punch staff. Patient #1 kicked the door and obtained a laceration to his left toe. He was seen by the nurse practitioner who gave orders for Patient #1 to be sent to emergency room for closure of laceration. Patient returned to facility with 3 police officers due to extreme aggression, biting and fighting.

Review of Patient #1's plan of care following incident on 03/12/2023, failed to reveal that new interventions were implemented and that changes were made following the documented transfer to the emergency room. Further review failed to reveal that Patient #1's legal representative was provided with treatment options, risks, and benefits through treatment plan review and asked to sign the treatment plan following the incident on 03/12/2023.

In an interview on 06/12/2023 at 4:01 p.m., S1DON confirmed that the nursing care plan was not revised reflecting the emergency room visit or subsequent return with a police escort due to extreme aggression on 03/12/2023. S1DON further confirmed that Patient #1's legal representative was not notified of treatment options, risks, and benefits through treatment plan review and was not asked to sign the treatment plan following the incident on 03/12/2023.

Based on record review and interview, the hospital failed to ensure adherence to nursing policies and procedures requiring the patient or the patient's representative to be notified of a transfer or discharge. This deficient practice is evidenced by failure to contact the patient's Power of Attorney (POA) in 2 different incidences regarding transfer to a higher level of care in 1 (#1) of 5 (#1-#5) patients sampled.
Findings:

Review of hospital policy titled "Transfer of a Patient to an Acute Care Facility", revealed, in part: Section: Nursing, approved by Governing Body on 09/01/2022. Purpose, in part: To comply with regulatory guidelines regarding patient transfer. Policy, in part: If Oceans Behavioral Hospital is unable to adequately meet a patient's needs; a physician may order a transfer to a more appropriate facility. This policy applies to patients transferred to another psychiatric hospital or short-term acute care facility. Procedure, in part: The Social Worker or Nurse will notify the family members of the transfer (preferably prior to transfer unless an emergent condition does not allow).

Review of Patient #1's medical record dated 03/12/2023 at 4:20 p.m., revealed Patient #1 was transferred to hospital 'a' emergency department for treatment of a laceration to left toe requiring sutures.

Review of Patient #1's medical record failed to reveal evidence of nursing services/social services having notified Patient #1's POA of the incident involving transfer to the emergency department on 03/12/2023.

Review of Patient #1's medical record dated 03/19/2023 at 8:56 a.m., revealed Patient#1 was transferred to Hospital 'a' emergency department for treatment of dehydration and urinary tract infection.

Review of Patient #1's medical record failed to reveal evidence of nursing services/social services having notified Patient #1's POA of the incident involving transfer to the emergency department on 03/19/2023.

In a telephone interview on 06/13/2023 at 10:45 a.m., Patient #1's daughter stated that on 03/03/2023 she spoke with social worker at the psychiatric hospital and let them know she was the primary contact and had Power of Attorney regarding the care of her father. Patient #1's daughter reported that she told the social worker not to call her mother's phone because her mother had dementia and did not know how to answer the phone. Patient #1 reported that she called the psychiatric hospital on 03/17/2023 to check on her father and was told he had been transferred to the hospital on 03/12/2023 for treatment of the left toe laceration requiring sutures. Patient #1's daughter further stated that on 03/26/2023 she called the psychiatric hospital to check on her father and the social worker reported that the prior Sunday he had been transferred to hospital 'a' with dehydration and a urinary tract infection and had not returned to the psychiatric hospital. Patient #1's daughter reported that she was not notified that her father went to hospital 'a' until 1 week after he had been transferred.

In an interview on 06/06/2023 at 4:19 p.m., S1DON confirmed that Patient #1's daughter was his POA. S1DON also confirmed that there was no evidence that Patient #1's POA was notified of patient transfer to hospital 'a' emergency department on 03/12/2023 and 03/19/2023.