HospitalInspections.org

Based on staff interview and review of medical records, it was determined the hospital failed to ensure treatment plans for 3 of 9 patients (#4, #9, and #10), who had secondary diagnoses of autism or related diagnoses and whose records were reviewed, contained specific treatment modalities utilized by staff. This resulted in the potential for confusion among staff and the lack of a consistent approach to treating patients. Findings include:

1. Patient #4's medical record documented a 12 year old male who was admitted to the hospital on 2/03/11 and discharged on 2/23/11. Diagnoses included mood disorder-bipolar, borderline narcissistic spectrum disorder, attention deficit hyperactivity disorder, and autism. Patient #4's record documented disruptive and dangerous behaviors including running up to and aggressively hugging people with enough force that he had the potential to knock them over. He also surreptitiously touched females' breasts. The physician progress note, dated 2/11/11 at 12:16 PM, stated Patient #4 "...did at one time jump at the counselor or therapist and the therapist was able to keep him at a distance. I did discuss using CBMT when he rushes to hug people. He has also been warned that this can be dangerous and that he can hurt people by doing that and so I recommended that they instruct the staff about CBMT." The "NURSING FLOW SHEET," dated 2/15/11 at 3:20 PM, stated "Pt was very hyper, labile- grabbing at peers breasts and vaginal area."

Patient #4's "MASTER TREATMENT PLAN," dated 2/06/11, addressed aggression but it did not include specific modalities which addressed the hugging and sexual behavior. CBMT was not included and described on his treatment plan. The plan was not updated after 2/06/11.

The Charge Nurse for the unit Patient #4 resided on was interviewed on 3/10/11, beginning at 2:00 PM. She stated staff isolated Patient #4 from other patients and assigned one to one staff to him. However, this was not included on the treatment plan. She stated staff dealt with Patient #4's behaviors in different ways. For example, she stated when he rushed at staff to hug them, some staff told him to give them a high five instead and some staff attempted to use a "side hug." She stated she was not aware of what CBMT was. She stated staff did not have a uniform approach to Patient #4's behaviors and said these were not addressed on his treatment plan. She also stated staff used different interventions when Patient #4 was hyperactive, including a pressure vest, to calm him. She said sometimes these interventions worked and sometimes they did not. She said these specific interventions were also not part of a treatment plan.

Specific treatment modalities were not included in Patient #4's treatment plan.

2. Patient #9's medical record documented a 15 year old female who was admitted to the hospital on 1/26/11 and was discharged on 2/03/11. Diagnoses included neurofibromatosis (a genetic disorder in which nerve cells grow tumors and can involve behavior changes). She also had a history of a leg and hip fracture in November 2010 for which she was still recovering. An order was written on 1/29/11 to place a copy of a "sensory diet" on Patient #9's wall. The sensory diet included sensory interventions based on how a person was feeling at a given time. Her "MASTER TREATMENT PLAN," dated 1/28/11, did not address the leg fracture or the sensory interventions. The plan was not updated after 1/28/11.

The Charge Nurse for the unit Patient #9 resided on was interviewed on 3/10/11, beginning at 2:00 PM. She stated she did not know what the sensory diet was but thought it had been written on a communication board. She stated Patient #9 had an exercise program for her leg that staff assisted her with. She reviewed the medical record and confirmed the treatment plan did not address these items.

Specific treatment modalities were not included in Patient #9's treatment plan.

3. Patient #10's medical record documented a 14 year old male who was admitted to the hospital on 12/23/10 and was discharged on 1/13/11. Diagnoses included bipolar disorder, fetal alcohol spectrum disorder, and autism. OT recommendations, which were signed by the physician on 1/05/11, included a sensory diet, "engine level education," and the use of a "sensory brush" 2-3 times a day. His "MASTER TREATMENT PLAN," dated 12/24/10, did not address the sensory interventions. The plan was not updated after 12/24/10. Interdisciplinary Team Notes did not document the use of the sensory interventions or their effectiveness.

The Director of the Adolescent Units was interviewed on 3/10/11, beginning at 2:55 PM. He reviewed Patient #10's medical record and confirmed the sensory items were not included on the treatment plan. He also confirmed the sensory interventions were not documented. He stated these measures would have been carried out by unit staff rather than by therapy staff.

Specific treatment modalities were not included in Patient #10's treatment plan.