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Based on interview and document review, the hospital failed to follow their grievance procedure for 1 of 10 patient records reviewed, when Patient #1 (P-1) voiced a concern to the hospital related to her care after the birth of her child and the hospital did not provide follow the grievance process including a written response to the patient.

Findings include:

Medical record review revealed P-1 was admitted to the hospital on 2/4/2015 for postdates induction of labor. The discharge summary dated 2/6/2015 revealed P-1 experienced a vaginal delivery and post-partum hemorrhage on 2/5/2015. During an interview on 4/27/2015 at 10:40 a.m., P-1 stated she experienced a post-partum hemorrhage about an hour after the baby's birth. P-1 stated she felt her patient rights were violated when the hospital staff proceeded to conduct a vaginal sweep to remove clots without fully explaining what her options were related to treatment. P-1 further stated she felt staff did not listen to her when she told them to stop, restrained her during the procedure, and her pain control was not adequate for the procedure. P-1 stated she spoke to the hospital's patient representative about her concerns, but they were not responsive, nor did she get any written response related to the concerns voiced. During an interview on 4/23/2015 at 1:00 p.m. Patient Representative L (PR-L) stated she received a phone call from P-1 the day of discharge (2/6/2015) indicating she had concerns about what happened after the delivery of her baby; a nurse laying over her during the sweep procedure and her lack of pain control. PR-L stated she put the concern in the data base, but did not identify it as a grievance, nor was the complaint treated as a grievance. PR-L stated the case was reviewed by another physician, but the hospital did not consider the concern a grievance, provide the patient with the required written response, or follow the grievance process. PR-L stated she called P-1 back as a follow-up (PR-L did not know the date) and offered to have the physician call her, but P-1 was not satisfied. PR-L stated she considered the concern a point of service concern, but looking back the patient was still dissatisfied and she could have handled it as a grievance.

The hospital policy titled Patient Grievance/Complaint Process effective date 3/12 was reviewed. Under Definitions: Grievance/Complaint: An issue raised by a patient/patient's representative that has not been resolved at the point of service, is too complex for point of service resolution, that requires investigation and/or requires further actions for resolution. A formal or informal written or verbal grievance/complaint that is made to the facility by a patient, or the patient's representative, regarding: dissatisfaction with the patient's care or caregivers, an adverse event, quality or appropriateness of care or harm related to care that requires a peer review protected assessment and corrective planning process. Under section VI. Grievance/Complaint Investigation, Conclusions and Written Response. C. The final written response must provide the patient with notice of the facility's decision, including the steps taken on behalf of the patient to investigate the grievance/complaint, the results of the grievance/complaint process, the date of completion, and the name of the facility's contact person.