HospitalInspections.org

Based on observation, interview, and record review of the patient bill of rights the facility failed to provide a notice of the patients' bill of rights when it failed to provide the patient/family a copy of the bill of rights as required by hospital policy in 100 percent of the geriatric psychiatric patients for the last three years. The facility also failed to provide patient rights to two patients (Patient #2 and #3) out of 4 patients interviewed on the medical surgical floor. The medical surgical census was 21. The hospital census was 35.

Findings include:

Review of Policy "Patient Rights and Responsibilities," Policy Number: SW.04.01, includes:
1) Procedure: SW.4.1.1 - Patient Rights and Responsibilities are provided to Citizen's Memorial Hospital (CMH) patients;
2) Procedure: SW.4.1.1 - If a patient cannot see or read, the document(s) will be read to them and explained as necessary.
3) Procedure: SW.4.1.6 -"Geropsychiatric Unit Patient Rights and Responsibilities:" Geropsychiatric Patients Rights are reviewed with the patient and/or the patient's representative/family member upon admission to the unit. A copy of these rights is given to the patient while the original is maintained/scanned into the medical record.

Review of the three page document titled, "Parkview Geriatric Wellness Center, Patient Orientation, Rights and Admission" is the patient rights document used in the Parkview Geriatric Wellness Center, which is the geriatric psychiatric area of the hospital. Page one of the document included the following patient rights:
-Each patient has impartial access to individualized treatment, regardless of race, religion, sex, ethnicity, age or handicap;
-Each patient's personal dignity is recognized and respected in the provision of care and treatment;
-Each patient has the right to request the opinion of a consultant at his or her expense or to request an in-hours review of the individual treatment plan;
-Patient's have the right to the following information: professional staff members responsible for the patient's care, nature of care, procedures and treatment that he or she will receive, the risk, side effects and benefits of all medications and treatment procedures used;
-Each patient has the right to be free from seclusion and restraint in any form imposed as a means of coercion, discipline, convenience or retaliation by staff. Seclusion or restraints can be used in emergency situations if needed to ensure the patient's physical safety and less restrictive interventions have been determined to be ineffective.


Interview with Staff J, psychiatric Registered Nurse, on 09/14/10 at 9:49 a.m. confirms the following: Prior to Friday, 09/10/10, the geriatric psychiatric staff RNs only reviewed the three page document called "Parkview Geriatric Wellness Center, Patient Orientation, Rights and Admission" with the patient/family and the patient/family did not receive the Patient & Visitors Service Guide (this guide included the patient rights the non-psychiatric patients receive). It is also confirmed upon admission the 3-page document titled, " 'Parkview Geriatric Wellness Center, Patient Orientation, Rights and Admission" was not given to the patients or their families as required by hospital policy which states, "Procedure: SW.4.1.6 - Geropsychiatric Unit Patient Rights and Responsibilities: Geropsychiatric Patients Rights are reviewed with the patient and/or the patient's representative/family member upon admission to the unit. A copy of these rights is given to the patient while the original maintained/scanned into the medical record." This employee confirms a copy of the "Parkview Geriatric Wellness Center, Patient Orientation, Rights and Admission" was only given to patients/families if it was directly requested from the patient or family. This employee confirms this was the routine practice for at least the last three years on the geriatric psychiatric unit and confirms it has been at least three years since the facility gave the geriatric psychiatric patients the patient rights like the non-psychiatric patients receive in the hospital - the Patient & Visitors Service Guide.

As a result of this survey on 09/10/10, the geriatric psychiatric patients began receiving a copy of the Patient & Visitors Service Guide that does include the patient rights.










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During an interview on 09/07/10 at 2:00 p.m., Patient #2 stated he/she had not received a copy of patient rights since he had been admitted approximately 24 hours ago. Family was present in the room and verified no patient rights had been given to the patient or family members.

During an interview on 09/07/10 at 2:20 p.m., Patient #3 stated he/she had not received a copy of patient rights since he had been admitted two days ago. Family was present in the room and verified no patient rights had been given to patient or family member.

During an observation on 09/07/10 at 2:25 p.m., while exiting Patient #3's room, Staff M, Social Services entered and was carrying a stack of admission packets in his/her arms.

During an interview on 09/07/10 at 2:30 p.m., Staff E, Medical Surgical Director stated patient care technicians are responsible for giving the admitting patient their patient rights. The patient rights are included in the admission packets which are given to the patients upon admission. The patient rights are not reviewed with the patient unless the patient requests it.

During an observation on 09/07/10 at 3:00 p.m., both Patient #2 and Patient #3 had admission packets laying on their bedside table containing a copy of the patient rights.

During an interview on 09/07/10 at 3:00 p.m., Patient #2's family stated someone had just brought the admission packet into the room and left it for the patient.

During an interview on 09/07/10 at 3:01 p.m., Patient #3 stated he/she received a copy of the patient rights immediately after this surveyor left the room.

Based on observation and interview the facility failed to provide personal privacy for the patients in Parkview Geriatric Wellness by displaying their full first names in public view for seven patients. The census was eight.
Findings Include:
1. Observation on 09/08/10 at 2:05 p.m., in the Parkview Geriatric Wellness unit, showed seven full first names on the outside of patient rooms. The names were in full view of anyone coming into the unit. The facility failed to protect the personal privacy of the patient.
2. Interview on 09/08/10 at 2:05 p.m., Staff J, RN (Registered Nurse) revealed the first names of patients were routinely displayed on the outside of rooms. This Staff RN would ask for permission upon admission of the patient to the unit, to use the patient's first name. However, he/she did not know if other staff asked for permission. There was not a policy for using names or obtaining permission.
3. Interview on 09/08/10 at 2:10 p.m. with Staff K, RN revealed that visitors come into that unit and all full first names are in public view.

Based on interview and record review the facility failed to keep patients free from abuse or harassment by not following policy and by failing to investigate abuse allegations to a point of determination. The hospital census was 35.
Findings Include:
1. Review of policy number SW.05.02, titled "ABUSE", initiated 06/15/92 with a revision date of 06/10/09, showed "Investigation: Personnel will complete an Event Report for further investigation by nursing administration, the Administrator and /or other disciplines within the facility or outside, in order to ensure resident safety and quality care".
2. Interview on 09/08/10 at 2:55 p.m., with Staff H, Director of Human Resources, revealed when Staff V, MHT (Mental Health Tech.) was informed of their termination on 08/04/10, he or she made allegations of patient abuse by three other employees. There was no evidence an event report was completed documenting these allegations.
3. Review of the investigation of allegations made by Staff V showed six handwritten interviews completed by Staff D, CNO (Chief Nursing Officer). The interviews were given to the surveyor on 09/08/10. There was no documented evidence of determination in the three allegations.
4. Review of the interview completed by Staff D on 09/08/10 with Staff L, RN revealed:
-Staff V showered Patient #10 and wanted to shave him.
-Patient #10 refused to be shaved and Staff V stated, "You are going to get it anyway."
-Staff L, RN asked for Staff V to let this go and Staff V stated, "That's the way you handle him, you have to show him who is boss and let me handle it".
-Staff L, once again asked Staff V, to let Patient #10 calm first, and Staff V stated, "No, he is going to get this done".
-Patient #10 started swinging at Staff V and Staff V held the patient's hands against his abdomen and the patient head-butted and kicked toward Staff V.
-Staff L called for security to assist with the patient as well as Staff V. Staff V refused to step away from the patient to allow the patient to de-escalate.
-Staff V released his/her hold on the patient after security was called.
-Patent #10 got up and walked toward his/her room
-Staff V threw his/her hands up and said, "You should have just let me handle it".
5. Review of the record titled, "Citizens Memorial Hospital, Security Activity Log,
Incident Memo revealed that the above incident occurred on 06/19/10 and
security responded at approximately 2:10 p.m.

6. Review of the report titled, "Event Report" dated 06/19/10 revealed a description of the incident between Staff V and Patient #10. This report was completed by Staff L and signed by Staff Y, Unit Manager on 06/21/10 at 9:05 a.m. The Event Report was also signed by Staff D,but without date or time.

7. Review of the policy titled "Disciplinary Action" initiated 06/15/92, and revised 09/09/05 revealed a violation that would require disciplinary action was HR.3.7.2 "Using abusive, profane, coercive, intimidating, or threatening language toward patients, residents, clients, customers, or fellow employees, patents, residents, clients, visitors, or customers".

8. Review of a typed document dated 06/21/10 at 9:05 a.m. and signed by Staff Y with a date after the signature of 06/21/10 was a conversation between Staff Y and Staff V which revealed:
-Staff V's voice was firm, but he/she did not yell at the patient.
-Staff V's hand placement was over the patient's with an open palm against
the patient's abdomen.
-Staff V, discussed concerns with Staff L, the calling of security, and others
who responded when the page was heard.
-Staff Y, stated that since he/she was not present at the time of the incident
he/she would drop the issue.
-There was no documented evidence of any disciplinary action or investigation
into the incident between Staff V and Patient #10. Thus, the facility failed to
follow their policy of violations that require disciplinary action.

Based on interview and record review the facility failed to obtain restraint orders from a physician who is responsible for the care of the patient and follow the hospital policy for restraint/seclusion in five out of nine closed records reviewed. No current patients with restraints. The hospital census was 35.
Findings Include:
1. Review of the policy titled "Restraint/Seclusion", initiated 06/15/92 with a revision date of 12/15/09 revealed:
-The use of restraint/seclusion will be used in accordance with the order by a physician who is responsible for the care of the patient and authorized to order restraint/seclusion;
-The order for restraint/seclusion used for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member, or others may be renewed in accordance with the following limits for up to a total of 24 hours;
2. Interview on 09/13/10 at 10:40 a.m. with Staff T, RN, IT (computer) Specialist and Staff U, RN, Director of ICU (Intensive Care Unit) and the Telemetry Unit, revealed the standard practice within the hospital was to obtain new orders for restraints every 24 hours.
3. Review of clinical record for Patient #28 revealed on 06/14/10 at 1:02 p.m., soft left wrist restraints were applied. There was no documented evidence an order for restraints was obtained.
4. Review of clinical record for Patient #29 revealed on 06/22/10 at 5:37 p.m. soft right wrist restraints were applied. An order was obtained at 06/21/10 at 5:30 a.m., the next order was obtained on 06/22/10 at 7:02 a.m., and the next order was obtained on 06/23/10 at 7:10 p.m. The facility failed to obtain orders for the restraint every 24 hours.
5. Review of clinical record for Patient #30 revealed on 06/29/10 at 12:02 a.m. soft, bilateral (left and right) upper extremity (arms-part of the arm [wrists]) restraints were applied. The order was not obtained until 06/29/10 at 7:53 a.m. The staff failed to obtain an order and had an individual in restraints for over seven hours before obtaining the order.
6. Review of clinical record for patient #32 revealed on 06/27/10 at 8:15 p.m., soft, right wrist restraints were applied. There is no documented evidence an order for restraints was obtained.
7. Review of clinical record for Patient #36 revealed on 09/08/10 at 9:00 p.m. soft, left wrist restraints were applied. An order was obtained on 09/09/10 at 3:06 a.m. The staff failed to obtain an order as soon as possible. The patient was in restraints for a little over six hours without an order.