HospitalInspections.org

Based on facility policy/procedures, medical record documentation, and interviews, Employee Identifier (EI) #1 failed to follow the hospital policy, and failed to obtain consent from Patient Identifier (PI) # 1, before allowing PI #1's work supervisor to remain in the room during PI# 1's nursing triage assessment on 3/27/2010.
This deficient practice affected 1 of 11 sampled patients (PI # 1).

Findings Include:

1. Policy/Procedure:
The hospital policy entitled "Patient Rights" includes:
"As a patient of (Hospital A), you (and your family) are entitled to certain considerations based on ... law, custom or moral obligation. The following list of entitlements has been established by the Board of Directors, management and staff of (Hospital A). Your rights include, but may not be limited to:
...Expect that any discussion or consultation involving your care be conducted discreetly and that individuals not directly involved in this care will not be present without you permission..."

2. PI #1's emergency room (ER) record, dated 3/27/2010, includes:
Initial Assessment Form
Priority: 4 Non-Urgent..
Presentation time: 14:33.
Triage time: 15:08...
Chief complaint: Headache new onset.
Brief assessment:
PCP (primary care physician)
follow up in 2 days from 3-26-10.
Patient returned visit c/o (complaint
of) headache.
(Employer) required urine drug
screen (UDS).
Pain intensity scale: 7/10.
Pain location: Head...

Emergency Department Ongoing Nursing Assessment
15:25 Pt to Rm (room) 2 post triage.
Supervisor... c (with) pt stated pt must go
through ER process if needed to gain U/A
(urine) D/S (drug screen).
(ER physician)...advised.
15:40 (ER physician) @ (at) BS
(bedside).
16:15 Lab on the way for urine drug screen.
16:40 Lortab 7.5 po.
16:49 Pt printed for discharge...

Summary Sheet:
History (if injury, how / why): (Supervisor)
has to be here when UDS is done.

3. Interviews:
Patient Identifier (PI) #1, interviewed on 5-18-10 at 10:30 AM, stated, "I distinctly asked him (Employee Identifier #1 - EI #1) with her (Supervisor) standing there if she (Supervisor) had to be there. He (EI #1) said that he wanted her (Supervisor) there. Because she (Supervisor) was there I could not give accurate information for fear of reprisal. I could not be truthful about my medical history. I should have said that I didn't want her (Supervisor) present while he (EI #1) was getting my health information but I didn't. No third party should be there to hear my responses, my blood pressure, pulse, etc., unless I ask them to be present... I asked that (EI #1) 'Does she (Supervisor) have to be here?' and he (EI #1) said 'Yes.'"

The Triage nurse (Employee Identifier [EI] #1), who worked on 3-27-10 from 11:00 AM to 11:00 PM, was interviewed on 5-12-10 at 11:05 AM, and again on 5-18-10 at 11:55 AM. EI #1 stated:

"She (PI #1) invited her (patient) supervisor into the triage room. I (EI# 1) had called the patient (PI #1) into triage, was ready to start the triage process, when she (PI #1) stopped me and wanted me to hold the door open for her supervisor to come into the triage room because this is a workman's comp case. I did not ask the patient (PI #1) specifically if it was okay for her supervisor to be present during the triage process. The patient (PI #1) is the one who asked to have her supervisor come into the triage room. I took that as she wanted to have her supervisor present. She (PI #1) didn't make any objection at any time to her supervisor being present or that she (PI #1) was uncomfortable with her supervisor being present. We already had her (PI #1) health information from the ER visit from the day before. I asked her (PI #1) if there were any changes in her meds, health history, etc., from the day before so she (PI #1) wouldn't have to give out that information in front of her supervisor. I think it was towards the end of the triage that she (PI #1) wanted to know how much longer the supervisor had to stay. I said 'She (Supervisor) night need to stay here to answer questions about workman's comp."

This deficiency was written as a result of the investigation of complaint number AL00022407.