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Based on interview and record review the facility failed to protect 1 patient (P-12) from neglect and failed to provide notice of rights to 1 patient (P-12), resulting in the potential loss of rights for all patients served by the facility. Findings include:

See specific tags:

0117 - Failure to provide notice of rights.
0145 - Failure to prevent neglect.

Based on document review and interview the facility failed to protect the rights of one (P-12) of 2 incapacitated observation patients reviewed requiring the Medicare Outpatient Observation Notice (MOON), resulting in the failure to inform the patient's representative the patient's status was outpatient, and the implications of this status, resulting in the loss of rights for the patient. Findings include:

On 9/18/23 at 1300 a review of P-12's medical record with Staff Z revealed that P-12 was admitted to Unit 7 East as a hospital outpatient on 4/15/23 at 0129 and discharged on 4/20/23 at 1230. Review of P-12's Medicare Outpatient Observation Notice (MOON) document in the record revealed the document was completed on 4/16/23 at 0221 and signed by the presenter with a note in the section titled "understanding of this notice": "Pt. has dementia, non-verbal, unable to sign". No documentation was found that spouse (patient representative) was informed.

Policy/Procedure addressing MOON was not available to review at time of survey.

On 9/19/23 at 1330 an Interview with Quality Director Staff C revealed a policy regarding MOON notification could not be found at time of survey, and it used to be addressed in the Important Message from Medicare Policy. Policy titled, "Important Message from Medicare" dated 4/10/22 was provided, review found no mention of the MOON process. It was noted under 4. When the beneficiary is unable to comprehend the notice ...the notice must be delivered ...to the beneficiary's representative to be signed. Staff C queried on the signing of documents by the representative if beneficiary is unable to sign, and she stated that it would be expected.

CMS requires notification to individuals receiving observation services as outpatients for more than 24 hours explaining the status of the individual as an outpatient, not an inpatient, and the implications of such status. In addition, CMS requires an oral explanation of the MOON to be provided, ideally in conjunction with the delivery of the notice, and a signature must be obtained from the individual, or a person acting on such individual's behalf, to acknowledge receipt.

Based on interview and record review the facility failed to provide nutritional support for 1 patient (P-12) with high caloric needs, resulting in neglect of P-12's physical needs and the potential for harm to all patient who are NPO (no intake by mouth). Findings include:

Review of P-12's medical record, with the assistance of Staff Z, on 09/18/23 at approximately 1300 revealed that P-12 was a 77-year-old female who presented from a nursing home on 04/14/2023 with a history of dementia, aphasia, dysphagia, and a large pressure ulcer (wound). P-12 presented with a chief complaint of a dislodged feeding tube; which was placed about 4 weeks prior to arrival to the Emergency Department (ED). A consult to Gastrointestinal (GI) Services for percutaneous endoscopic gastrostomy (PEG) tube was ordered on 04/14/2023. GI Services evaluated the patient and planned for PEG tube placement on 04/17/2023 with orders to keep P-12 NPO.

Further review of P-12's medical record revealed that on 04/17/2023 the PEG procedure was postponed to 04/18/2023. On 04/18/2023, the spouse, after being informed that the procedure was going to postponed until 04/19/2023, voiced a complaint to the patient advocacy department with concerns of delay in care and P-12's lack of nutrition for 5 days. After P-12 voiced their concerns to the unit manager, the unit manager contacted the endoscopy department and P-12 was added back to the schedule and received her PEG tube on 04/18/2023. Documentation review revealed P-12 was NPO since 04/14/2023 with no additional nutritional support until her tube feedings resumed on 04/19/2023.

Interview with Dietitian Staff BB on 09/19/2023 at 1300 revealed that she completed a nutritional consult on P-12 on 04/18/2023 (ordered 04/17/2023). Staff BB was queried on nutritional value of Intravenous (IV) fluids, and she stated not much nutritional value, but, good to maintain hydration.

There were no additional orders to provide P-12 with supplemental nutrition while she awaited PEG tube placement. There was no documentation reflecting why P-12 could not receive nutrition via an alternative route. Post incident, the facility did not implement corrective actions to address the concern that a patient did not receive nutritional support for 5 days.