HospitalInspections.org

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Based on observation and staff interview, the facility failed to ensure that the patient care environment was maintained in a safe and sanitary manner.

Findings include:

1. On 01/09/19 at 10:40AM, it was observed that the cove base (the lower part of the wall that connects to the floor tiles) was missing on all the four (4) sides of the Dining area. The lack of cove base made the wall surface rough and coarse. This is a potential safety hazard since one can cause self -harm by kicking the wall with the foot.

In addition,this is an infection control issue as this arrangement created a gap/opening between the wall and the floor of the Dining area, causing the collection of dust/dirt, potentially harboring microbes onto the wall, or creating a safety hazard if patients were to ingest the dust/dirt/wall fragments or particles.

An interview with Staff L (Director of Engineering) confirmed this finding.

2. On 01/08/19 at 11:42AM, it was observed that the ceiling air ventilation outlets in the Medication Room in Valentine Building SE 2, had a heavy dust buildup on it. This unclean vent posed a potential issue of cross contamination of the counter used in the drawing and preparation of medications.

An interview with Staff L on 01/08/19 at 11:43AM confirmed this finding.

3. On 01/07/19 at 1:30PM, it was observed that the two (2) duplex electrical outlets in Patient Rooms #2 and #3 in the Admission area were not of tamper resistant type. Further interview and observation revealed that the electrical outlets in Rooms # 1 and #4 were also not the tamper resistant type. The non tamper-resistant outlets can potentially be used for self-harm by electrocution.

An interview with Staff L on 01/07/19 at 1:32PM confirmed this finding.

4. On 01/09/19 at 11:16AM, it was observed that the examination chair/table in the Exam Room by the Nursing Station on the 2nd Floor of the Jennings Building was plugged into a non-hospital grade electrical outlet. This practice contrasts with the exam table Manufacturer's Direction For Use (DFU) recommendations, which require the exam table be plugged into a hospital grade electrical outlet. An interview with Staff L on 01/09/19 confirmed this finding.

5. On 01/08/19 at approximately 10:45AM, it was observed that patient storage closets in Rooms # 143, #166 and #175 in the Valentine Building have approximately a quarter (1/4) inch gap at the top of the hinge. A further investigation revealed that this situation existed in eleven (11) additional patient rooms. This arrangement of gaps at the top of the hinges of the closet doors posed a potential ligature risk. An interview with Staff L on 01/08/19 at 11: 50AM confirmed these findings.
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Based on Medical Record review, interview and document review, in three (3) of seven (7) Medical Records, the Case Coordinators (CC) did not provide patients or their representatives a list of available Skilled Nursing Facilities (SNFs), Adult Homes (AHs) or Home Health Agencies (HHAs), or document that a list was provided as required by facility Policy.

The failure to provide a facility list for post hospital care services potentially limits the patient's or representative's choices.

Findings include:

Review of Patient #30's Medical Record identified the following information: The patient was admitted on 10/27/18. The CC's Contact Note dated 10/29/18 at 4:51PM stated, "Daughter requesting assistance with SNF placement as patient is no longer manageable at home." The CC's Contact Note dated 11/01/18 at 12:40PM stated, "spoke with daughter on 10/31/18 and today ... writer starting process for SNF placement ... reviewed process with daughter ...". The CC's Contact Note dated 11/02/18 at 12:54PM stated, "PRI [Patient Review Instrument] sent to the following [seven SNFs] ... Will follow up." There was no documented evidence that the patient's daughter was provided with a list of available SNFs to select from.

Review of Patient #31's Medical Record identified the following information: The patient was admitted on 10/08/18. The CC's Contact Note dated 10/09/18 at 2:42PM stated "... Daughter verbalized she is looking for assistance with SNF placement. Writer educated daughter on process of SNF placement ...". The CC's Contact Note dated 10/11/18 at 2:15PM stated, "spoke with daughter ... and informed of plan to send out PRI for SNF placement ... PRI was faxed to the following SNFs [four SNFs] ... Will follow up." There was no documented evidence that the patient's daughter was provided with a list of available SNFs to select from.

The same failure to provide a list of available SNFs, AHs or HHAs to the patient or patient representative was identified in the Medical Record of Patient #35, for the review period of 01/07/19 to 01/11/19.

During interview of Staff K (Case Coordinator) in the presence of Staff I (Administrator), on the morning of 01/09/19, Staff K stated, "I tell the family about available facilities and look at facilities near the patient's family home, [then] will have them [the family] check out any accepting facility. But there is no written list available."

During an interview with Staff I at the same time on 01/09/19, Staff I confirmed no lists were available or provided to patients and/or their representatives.

The facility Policy and Procedures titled "Discharge Planning" last revised 03/16/17, contained the following statement: "Patients / caregivers will be provided lists for the next level of care including HHA, SNF and Sub Acute Rehab, if applicable. The medical record will reflect this communication ...".
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Based on document review and interview, the facility's Social Work/Therapeutic Services Department did not analyze readmission data collected related to the cause for readmission, beyond the discharge planning process, to identify readmission trends.

Lack of readmission data analysis could result in a failure to identify opportunities for discharge planning improvement.

Findings include:

The "Discharge Planning Review" Tool used to identify potentially preventable readmissions from the third quarter of 2018, revealed that the Social Work Staff recorded the 30-day re-admissions rates, but could not present documented evidence that the causes for the readmissions were reviewed, analyzed, or discussed.

Review of the "South Oaks Utilization Committee" Meeting Minutes from February 7, 2018, revealed that the Committee reported the percentage of 30-day readmissions, but no analysis of the discharge planning process or identified causes was presented. There was no documented evidence that preventable readmissions had been identified or in-depth reviews conducted to determine whether discharge evaluations, plans and implementation were appropriate.

Per interview of Staff I (Administrator) during the morning on 01/09/19, Staff I stated that the information collected about the reason or cause for the readmission is discussed at the Supervisors' Meeting, but this is an informal meeting with no documented minutes. If an issue is identified by a Supervisor, it is dealt with on an individual basis with the Case Coordinator involved. There is no current trending done.

Staff I could not provide any documented evidence of supervisory reviews during this interview nor explain how this information was used to evaluate the effectiveness of the discharge planning process.

Based on policy review, record review and interview, the facility failed to develop individualized Master Treatment Plans (MTPs) that identified patient-related short-term goals stated in observable, measurable, behavioral terms for ten (10) of ten (10) active sample patients (A1, A2, A3, A4, A5, B1, B2, B3, B4 and B5). In addition, many Master Treatment Plans contained similarly worded short-term goals which were not measurable outcome behaviors. This deficient practice hinders the treatment team's ability to measure behavioral changes in the patient and may contribute to failure of the team to modify the Master Treatment Plans in response to patients' needs.

Findings include:

A: Policy Review

1. Facility policy titled "Treatment Planning" effective 12/75, last reviewed 8/18/18 and implemented 8/23/18, stated, "The purpose of treatment planning is to identify the patient's goals and staff interventions that will guide the treatment process." Section entitled, "Treatment Plan Training Key" number six (6), stated "OBJECTIVES (short-term goals): The objectives are to be formulated by the interdisciplinary team and are patient-focused (NOT staff/discipline-focused) short-term goals. They are written in behavioral terms that are measurable, to ensure objectivity and clarity of communication within the treatment team and to ensure that staff will be able to determine at which point the goals have been met. They are also individualized for each patient." This policy was not followed in the formulation of the goals on the treatment plans, as they were not individualized or measurable.

B. Record Review

1. Patient A1: MTP dated 1/4/19 identified the "Presenting Problems" as "Mood alteration: depressed -pt. [patient] reports poor sleep, poor appetite, and poor concentration; feeling isolated and taken for granted. Cognition: impaired - daughter reports pt. is confused, forgetting mechanics of locking doors, needs help with managing the home, paying bills. Family/significant other discord - Pt. refuses to talk to daughter, accuses daughter of trying to steal (his/her) home. Suicide, risk for - pt. reports wanting to slit [his/her] throat prior to admission."

a. Short-term goal: "Will take medication as prescribed 100% (percent) of the time." This was a staff expectation and was not measurable.

b. Short-term goal: "Will verbalize pleasure/+ experience of engagement in unit activities." Goal was not specific, observable or measurable.

c. Short-term goal: "To reduce frequency, duration, and intensity of periods of anxiety/agitation related to impaired cognition." Goal was not written in behavioral, not observable or measurable terms.

d. Short term goal: "To reduce frequency, duration, and intensity of periods of anxiety/agitation related to impaired condition." This was a staff expectation and not a patient goal. It was not observable or measurable.

e. Short-term goal: "Will exhibit zero (0) incidents of aggression/alteration during visiting or on the phone."

2. Patient A2: MTP dated 1/2/19 identified the problem as follows; "Mood alteration: manic or labile - hyperverbal/demanding/intrusive. Cognition: impaired - pt. is confused/disorganized, focused on going home. Agitation - pt. becomes aggressive/combative with staff. Violence, Risk for - pt. becomes physically violent toward staff related to increased focus on wanting to leave. Anxiety interfering with daily functioning - pt. is focused on going home, increased intrusive and demanding with staff."

a. Short-term goal: "Will exhibit zero (0) incidents of self-harm weekly. To reduce severity and improve coping skills related to mania/mood lability so that it does not interfere with daily functioning." Goal was a staff expectation and not measurable.

b. Short-term goal: "Will accept assistance in feeding, and ADLs (activities of daily living skills) without resistance or combative behavior 75% of the time." Goal was a staff expectation and not measurable.

c. Short-term goal: "Will decrease periods of agitation to (two times) 2x daily." Goal was a staff expectation and not measurable.

d. Short-term goal: "To remain free from harming self and others." Goal was a staff expectation and not measurable.

e. Short term goal: "To cope with anxiety-arousing situations effectively so that anxiety does not interfere with daily functioning." Goal is not measurable.

3. Patient A3: MTP dated 1/2/19 identified the problem" as "Mood alteration: depressed. Thought process: altered. Cognition: impaired - pt. is on autism spectrum. Self-harm, risk for - pt. has hx. (history) of cutting. Suicide, risk."

a. Short term goal: "To reduce severity and improve coping skills related to depression so that it does not interfere with daily functioning." Goal was a staff expectation and not measurable.

b. Short-term goal: "To reduce severity and improve coping skills related to psychosis so that it does not interfere with daily functioning." Goal was a staff expectation and not measurable.

c. Short-term goal: "To reduce frequency, duration, and intensity of periods of anxiety/agitation related to impaired cognition." Goal was a staff expectation and not measurable.

d. Short-term goal: "To remain free from self-harm." Goal was a staff expectation and not measurable.

4. Patient A4: MTP dated 1/4/19 identified the problem as "Insight into illness: Impaired: Patient presents discharge focused asking "when can I go? I have prior obligations I can't miss." Mood alteration: depressed: Patient presents with depressed mood and flat affect. Cognition: impaired: Patient is a poor historian. Thought process: altered: Patient presents internally pre-occupied talking to (him/her- self) stating "just plug it in ...plug it in." Substance use/abuse/dependence: Patient recently relapsed on a pint of vodka."

a. Short-term goal: "To gain an understanding and acceptance of the disease process/illness." Goal was a staff expectation and not measurable.

b. Short-term goal: "To reduce severity and improve coping skills related to depression so that it does not interfere with daily functioning." Goal was a staff expectation and not measurable.

c. Short term goal: "To reduce frequently, duration, and intensity of periods of anxiety/agitation related to impaired cognition." Goal was a staff expectation and not measurable.

d. Short-term goal: "To reduce severity and improve coping skills related to psychosis so that is does not interfere with daily functioning." Goal was a staff expectation and not measurable.

e. Short term goal: "To be abstinent from drugs/alcohol/gambling." This goal was not measurable

5. Patient A5: MTP dated 12/31/18 identified the problem as "Thought process: altered - disorganized, bizarre, thought blocked. Substance abuse use/abuse/dependence - utox urine toxicology) + THC (Tetrahydrocannabinol), was residing in a sober home. Anxiety interfering with daily functioning."

a. Short-term goal: "Will take medication as prescribed 100% of the time." Goal was a staff expectation and not measurable.

b. Short-term goal: "To be abstinent from drugs/alcohol/gambling." Goal was a staff expectation and not measurable.

c. Short-term goal: "To cope with anxiety-arousing situations effectively so that anxiety does not interfere with daily functioning." Goal was a staff expectation and not measurable.

6. Patient B1: MTP dated 1/4/19 identified the problem as "Mood alteration: depressed: pt endorses anhedonia, anergia, insomnia, weight loss and hopelessness."

a. Goal: "To reduce severity and improve coping skills related to depression so that it does not interfere with daily functioning." The goal was not measureable.

b. Goal: "To be abstinent from drugs/alcohol/gambling." "Will exhibit 0 instances of drug use while in treatment." Target date was 1/12/19. This was a staff expectation and an unrealistic short-term goal, since the patient was expected to be hospitalized during this time period.

c. Goal: "To remain free from self-harm." This goal was a staff expectation and was not individualized.

7. Patient B2: MTP dated 1/5/19 identified the problems as "agitation" and "mood alteration: manic or labile."

a. Goal: "Will accept PRN medication by mouth 100% of the time when offered by nurse." This goal was a staff expectation.

b. Goal: "To reduce severity and improve coping skills related to mania/mood lability so that it does not interfere with daily functioning." This is a staff expectation and is not measureable.

8. Patient B3: MTP dated 12/30/18 identified the problem as "Impulsivity: Patient has been increasingly impulsive at home, engaging in dangerous behaviors (ex. property destruction, self-harm)"

a. Goal: "To improve ability to think before acting." The goal was not measureable.

b. Goal: "To remain free from self-harm." This goal is a staff expectation.

9. Patient B4: MTP dated 12/9/18 identified the problem as "Mood alteration: depressed: Pt reports feelings of helplessness and hopelessness."
a. Goal: "To reduce severity and improve coping skills related to depression so that it does not interfere with daily functioning. Will take medication as prescribed 100% of the time." This is a staff expectation.

b. Goal: "To be abstinent from drugs/alcohol/gambling." "Will verbalize intent to attend self-help/support groups." This is a staff expectation.

c. Goal: "Pt endorsed SI (suicidal ideation), with plan to jump in front of a train or in front of traffic. Will exhibit zero (0) incidents of self-harm weekly." This goal is couched in the negative: i.e., the patient can meet it by doing nothing. It is also a staff expectation.

10. Patient B5: MTP dated 12/12/18 identified the problem as "Mood alteration: depressed: pt reports that s/he has been experiencing episodes of depression since 11 y/o (years old) that have been severely worsening in the last 2 months."

a. Goal: "To reduce severity and improve coping skills related to depression so that it does not interfere with daily functioning." "Will take medication as prescribed 100% of the time." This is a staff expectation.

b. Goal: Pt's goal is "to have less negative feelings." "Pt will present less depressed on unit" Target date: 12/12/18. This goal is not measureable.

C. Interview

1. In a meeting and review on 1/8/19 at 1:00 p.m., the Medical Director concurred with the findings that the goals were not measurable and observable.

2. In an interview with the Nurse Executive (Director of Nursing), on 1/8/19 at 2:30 p.m., the Treatment Plans were reviewed. The Nurse Executive acknowledged that the Treatment Plans goals were not individualized nor written in observable and measurable term. She stated "this will be the next big project."

3. In an interview with the Registered Nurse 1, on 1/8/19 at 3:00 p.m. Non-measurable goals were discussed. RN-1 did not dispute the findings.

Based on record review and interview, the facility failed to develop Master Treatment Plans (MTP's) that evidenced individualized treatment interventions with specific focus based on individual needs and abilities of 10 of 10 active sample patients (A1, A2, A3, A4, A5, B1, B2, B3, B4 and B5). Interventions were stated as generic monitoring and/or discipline functions, and specific groups assigned to each patient were sometimes not included. Also some plans did not include physician or nursing interventions. These deficiencies resulted in treatment plans that failed to reflect an individualized approach to multidisciplinary treatment, and to provide guidance to staff regarding the specific interventions and the purpose for each. This failure also potentially results in inconsistent and/or ineffective treatment.

Findings include:

A. Record Review

1. Patient A1: MTP dated 1/4/19 identified the problems as "Mood alteration: depressed -pt. [patient] reports poor sleep, poor appetite, and poor concentration; feeling isolated and taken for granted. Cognition: impaired - daughter reports pt is confused, forgetting mechanics of locking doors, needs help with managing the home, paying bills. Family/significant other discord - Pt. refuses to talk to daughter, accuses daughter of trying to steal [his/her] home. Suicide, risk for - pt. reports wanting to slit [his/her] throat prior to admission." The following generic and routine discipline functions were stated in the treatment plan for the identified problems:

a. Physician: "Prescribe medication: specify: ZOLOFT."

b. Nursing: "Administer medications as ordered."

c. Therapeutic Recreation: "Encourage pt to utilize creative outlets for thoughts and feelings. Encourage patient to participate in milieu."

d. Case Coordinator: "Encourage to socialize/participate in activities to modulate mood."

2. Patient A2: MTP dated 1/2/19 identified the problem as follows; "Mood alteration: manic or labile - hyper verbal/demanding/intrusive. Cognition: impaired - pt. is confused/disorganized, focused on going home. Agitation - pt. becomes aggressive/combative with staff. Violence, Risk for - pt. becomes physically violent toward staff related to increased focus on wanting to leave. Anxiety interfering with daily functioning - pt. is focused on going home, increased intrusive and demanding with staff." The following generic and routine discipline functions were stated in the treatment plan for the identified problems:

a. Physician: "Prescribe medication: specify: Ativan, Luvox."

b. Nursing: "Assess and provide for special observation to keep patient safe from self-harm/harm to others. Administer medications as ordered. Offer PRN medication to patient during periods of escalating behavior. Give pt alternative to using his/her own room, unit phone to contact family members when becoming agitated. Notify attending MD or MOD when pt. attempts to hit staff members."

3. Patient A3: MTP dated 1/2/19 identified the problem" as "Mood alteration: depressed. Thought process: altered. Cognition: impaired - pt. is on autism spectrum. Self-harm, risk for - pt. has hx. (history) of cutting. Suicide, risk." The following generic and routine discipline functions were stated in the treatment plan for the identified problems:

a. Physician: No intervention listed on plan.

b. Nursing: "Acknowledge progress toward alleviating depressed mood. Administer medication as ordered."

c. Therapeutic Recreation: "Encourage patient to participate in milieu."

4. Patient A4: MTP dated 1/4/19 identified the problem" as "Insight into illness: Impaired: Patient presents discharge focused asking "when can I go? I have prior obligations I can't miss." Mood alteration: depressed: Patient presents with depressed mood and flat affect. Cognition: impaired: Patient is a poor historian. Thought process: altered: Patient presents internally pre-occupied talking to [him/her- self] stating "just plug it in ...plug it in." Substance use/abuse/dependence: Patient recently relapsed on a pint of vodka. The following generic and routine discipline functions were stated in the treatment plan for the identified problems:

a. Physician: "Prescribe medication: specify Zyprexa."

b. Nursing: "Administer medication as ordered."

5. Patient A5: MTP dated 12/31/18 identified the problem" as "Thought process: altered - disorganized, bizarre, thought blocked. Substance abuse use/abuse/dependence - utox (urine toxicology) + THC (Tetrahydrocannabinol), was residing in a sober home. Anxiety interfering with daily functioning." The following generic and routine discipline functions were stated in the treatment plan for the identified problems:

a. Physician: No intervention listed on plan.

b. Nursing: No intervention listed on the plan for nursing.

6. Patient B1: MTP dated 1/4/19 identified the problem as "Mood alteration: depressed: pt endorses anhedonia, anergia, insomnia, weight loss and hopelessness." The following generic and routine discipline functions were stated in the treatment plan for the identified problems:

a. Physician: "Prescribe medication: specify: EFFEXOR, SEROQUEL, KLONOPIN, NEURONTIN."

b. Nursing: "Encourage pt to attend groups and activities. Maintain a safe environment."

7. Patient B2: MTP dated 1/5/19 identified the problems as "agitation" and "mood alteration: manic or labile." The following generic and routine discipline functions were stated in the treatment plan for the identified problems:

a. Physician: No interventions listed on plan.

b. Nursing: "To remain free from serious medical complications of physical illness." "Will accept PRN medication by mouth 100% of the time when offered by nurse."

8. Patient B3: MTP identified the problem as "Impulsivity: Patient has been increasingly impulsive at home, engaging in dangerous behaviors (ex. property destruction, self-harm)" The following generic and routine discipline functions were stated in the treatment plan for the identified problems:

a. Physician: "Adjusting medications. Started Lamictal to help with poor frustration [sic] and agitation."

b. Nursing: "Will offer po prn's during times of increased agitation." "Provide 1:1 support as needed when pt is feeling overwhelmed."

9. Patient B4: MTP dated 12/9/18 identified the problem as "Mood alteration: depressed: Pt reports feelings of helplessness and hopelessness." The following generic and routine discipline functions were stated in the treatment plan for the identified problems:

a. Physician: No interventions listed on plan.

b. Nursing: "Assess pt for suicide risk."

10. Patient B5: MTP dated 12/12/18 identified the problem as "Mood alteration: depressed: pt reports that s/he has been experiencing episodes of depression since 11 y/o that have been severely worsening in the last 2 months." The following generic and routine discipline functions were stated in the treatment plan for the identified problems:

a. Physician: "Prescribe medication: specify: LEXAPRO, TRAZODONE."

b. Nursing: "Will take medication as prescribed 100% of the time." "Assess and provide for special observations to keep patient safe from self-harm."

B. Interview

1. In a meeting and review on 1/8/19 at 1:00 p.m., the Medical Director concurred with the findings that the interventions listed were routine physicians' tasks.

2. In an interview with the Nurse Executive (Director of Nursing) on 1/8/19 at 2:30 p.m., the Treatment Plans were reviewed. The Nurse Executive acknowledged that the Treatment plan interventions were not individualized and were routine Registered Nurses tasks.

Based on policy review, record review and interview, the facility failed to identify the specific staff persons who were primarily responsible for treatment interventions listed on the Master Treatment Plan for 10 of 10 active sample patients (A1, A2, A3, A4, A5, B1, B2, B3, B4, and B5). Instead, each intervention was listed under the clinical discipline title such as nursing, case management, attending physician, case coordinator, assistant coordinator, assistant counselor and TR (Therapeutic Recreation). This practice resulted in lack of staff accountability for the interventions and failure to deliver treatment that meets the patient's identified needs.

Findings include:

A. Policy Review

1. Facility policy titled, "Treatment Planning" effective 12/75 and reviewed 8/18/18, stated "Intervention: A staff-focused, action based plan to address each stated objective. Interventions are discipline-specific, individualized for each patient, and include a frequency/duration." This policy does not require the name of the primary responsible staff person to be listed with intervention in the disciplinary treatment plan.

B. Record Review (MTP dates in parentheses):

1. The MTPs for the following patients were reviewed (dates of plans in parentheses): A1 (1/4/19), A2 (1/2/19), A3 (1/2/19), A4 (1/4/19), A5 (12/31/18), B1 (1/4/19), B2 (1/5/19), B3 (12/30/18), B4 (12/19/18), B5 (12/5/18). This review revealed that the discipline title (Nursing, case management, attending physician, case coordinator, assistant coordinator, assistant counselor and TR (Therapeutic Recreation) was listed beside each intervention but not the responsible person's name and classification.

C. Interview

1. In a meeting and review on 1/8/19 at 1:00 p.m., the Medical Director concurred with the findings that the interventions listed had the clinical title listed without the responsible person's name.

2. In an interview with the Nurse Executive (Director of Nursing) on 1/8/19 at 2:30 p.m., the Treatment Plans were reviewed. The Nurse Executive acknowledged that "nursing" was listed beside each nursing intervention on the plans and not the responsible staff person's name.

Based on record review and interview, the Medical Director failed to ensure that:

1. The Master Treatment Plans for 10 of 10 active sample patients (A1, A2, A3, A4, A5, B1, B2, B3, B4, and B5) identified goals that were written in behavioral terms and were observable or measurable. These failure results in treatment plans that do not identify expected patient outcomes in a manner that can be used by staff to determine the effectiveness of care. (Refer to B121)

2. Therapeutic interventions were individualized and based on individual needs and abilities of 10 of 10 active sample patients (A1, A2, A3, A4, A5, B1, B2, B3, B4 and B5). The interventions were generic routine tasks that would be performed for all patients regardless of the different patients' problem and needs. This failure results in MTPs that fail to reflect an individualized approach to patient care and fail to guide the staff in providing treatment with specific focus. (Refer to B122)

Based on record review and interview, the Nurse Executive (Director of Nursing) failed to ensure that:

1. The Master Treatment Plans for 10 of 10 active sample patients (A1, A2, A3, A4, A5, B1, B2, B3, B4 and B5) identify goals that were written in behavioral terms and were observable or measurable. These failure results in treatment plans that do not identify expected patient outcomes in a manner that can be used by nursing personnel to determine the effectiveness of nursing care. (Refer to B121)

2. Nursing interventions were individualized and based on individual needs and abilities of 10 of 10 active sample patients (A1, A2, A3, A4, A5, B1, B2, B3, B4 and B5). The nursing interventions were generic routine tasks that would be performed for all patients regardless of the different patients' problem and needs. This failure results in MTPs that fail to reflect an individualized approach to patient care and fail to guide the nursing staff in providing treatment with specific focus (Refer to B122)

3. Responsible nursing staff were identified on the MTPs for 10 of 10 sample patients (A1, A2, A3, A4, A5, B1, B2, B3, B4 and B5). Instead of listing staff names, the treatment plans only identified nursing as responsible for the interventions. This failure can result in lack of staff accountability and failure to deliver treatment interventions to meet the patients' needs. (Refer to B123)