HospitalInspections.org

Based on review of policies and procedures, record reviews, and interview, it was determined the hospital failed to have policies and procedures established for all patients types presenting to the emergency department including obstetrical, unborn and newborn patients; and for psychiatric patients with homicidal tendencies who were held for extended periods of time awaiting placement.

Findings include:

A review of the statistics for the types of patients presenting to the emergency department revealed 2% of the emergency department visits for August 2014 were identified as obstetrical patients (13 of 590). This is a low volume. However; as identified in the he review of Patient #12's record who was admitted to the emergency department in October 2014, there were no specific guidelines to follow for the nursing personnel or the medical staff related to the care of obstetrical patients.

There were no documented policies and procedures for the assessment of the obstetrical and unborn infant.

Based on the hospital's statistics, there are approximately 2% psychiatric patients admitted to the emergency department. The hospital is in a position that they are required to hold some of those patients for greater than 24 hours due to limited resources for transfer to a higher level of care. When this occurs, the hospital is making a decision to move the patient to the in-patient acute care area of the hospital and maintain them as emergency department patients.

For example, Patient 35 was referred to the emergency department on 10/15/2014 at approximately 4 p.m. by a local provider of mental health services. The emergency department physician's documentation included: "...Long history of mental health issues. Seen by his mental health evaluator today and sent to ED for medical clearance for admission..." The patient was evaluated by the hospital's contracted mental health evaluator at 3:05 p.m. who documented the patient was "hostile" and impulsive." The evaluator also documented he had "Current" homicidal ideation and that he was "High" risk for Danger to others. The patient was transferred to the acute care medical unit at approximately 7:40 p.m. as a "Psych ER Hold." He remained on the unit overnight and was observed in a room on the unit by the surveyor at 8:30 a.m. on 10/16/2014.

The Director of Operations and the Director of Nursing acknowledged during interviews that the hospital had no protocols or procedures identified for nursing personnel for how these patients are maintained on the acute care unit related to assessments and reassessments, required safe environment, and the protection of the staff and other patients in the case of a homicidal patient.