HospitalInspections.org

Based on interview and document review the facility failed to follow their established admission policy by accepting a patient from jail. This placed the patient's and staff safety at risk for injury in 1 of 1 admissions.

On 3/13/2014 in the DON's office, the policy for admission was reviewed and revealed the following: Patient's considered for admission must be stabile and appropriate for admission to the facility, "patient's will not be admitted from the criminal justice system (local city or county jail)." Included in the policy was the statement, "When in doubt call the Psychiatrist on call for determination of the patient's appropriateness for the facility."

On 3/13/2014 at 9:00 AM interview with the DON revealed the following: On 2/21/2014 at 4:30 PM, the Admission Coordinator (AC) began the process for admitting a new patient (Friday afternoon.) The DON explained the admission was not appropriate. The DON further revealed the Admission's coordinator failed to followed the established facility policies. Patient #1 had previously been a patient at the facility and had exhibited violent and aggressive behavior that interfered with safe treatment. The AC had not reviewed the previous medical record nor shared the information found therein with the nursing staff or the Psychiatrist. The AC failed to notify the on call administrator for involvement in the admission process. The AC did not obtain accurate information from the police department prior to accepting the patient. Pt #1 was admitted from a county jail. He arrived via police car. He was in shackles at his hands, waste and ankles. He was escorted by 4 (Four) police officers. Upon placement in the secure unit he became uncooperative and aggressive, requiring immediate emergency medication which was administered intramuscularly. This was accomplished with the help of the police officers who were still present.
The DON explained following morning pt #1 became aggressive without obvious reason and with an open hand struck two (2) separate female patients, from the back, knocking them to the floor. A male patient attempted to intervene and was also knocked to the floor. Pt #1 physically assaulted two (2) nurses (female and male nurse). Outside help was called and 2 police officers, 4 firefighters, 2 Emergency Medical Service personnel and two (2 ) tasers were utilized to subdue Pt #1, enabling them to removed him from the facility.

On 2/13/2014 at 11:00 AM in he DON's office the Medical record (MR) for pt #1 was reviewed and revealed an Emergency Detention warrant (EDW) was presented by the county jail upon admission. Pt #1 was removed from a local Emergency Department by the police and taken to jail. The EDW sited "patient became aggression with staff and taken to jail, noncompliant and grossly psychotic."

Review of the History and Physical (H&P) revealed pt #1 was 5 ft and 11 inches tall weighing 303 pounds.

Further review of the Psychiatric short stay summary revealed the following: "The 34 year old male was brought to the hospital by ----- county police secondary to psychosis. The patient was in the (Acute) emergency room and after discharge, he would not leave the premises. The police had to be called and he was taken to jail. While the patient was in jail, he was irritable and tore up his mattress. The patient has been noncompliant with his medications and refused to take medications while at the jail. The patient has been responding to internal stimuli. He is paranoid. The patient became extremely agitated when he was brought on to the unit and had to be given a shot of Haldol 10 mg, Ativan 2 mg, and Benadryl 50 mg. The patient was jumping over the nurses station counter and charging into doors. He was aggressive toward staff and had to be secluded."

Review of the MR for patients #2, #3,and #4 revealed the following: All three (3) patients were transported to the local Emergency Department (ED) for evaluation. All three patients returned to the unit. Pt #4 returned with a hairline fracture to the lateral maleolus and distal second toe. She was placed in a boot and hard sole. Pt #3 returned with no further complaints and pt #2 returned with muscle strain. Both nurses were transported to the ED for evaluation and sent home with muscle strains. Replacement staff were called to work the remainder of the shift.

The DON indicated the Admissions Coordinator had submitted her resignation and it had been accepted.