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JOHNS HOPKINS HOSPITAL, THE
PATIENT RIGHTS: INFORMED CONSENT
Tag No.: A0131
Based on the review of 5 open medical records, 5 closed medical records, it was determined that the hospital failed to ensure that 1 of 3 psychiatric patients were informed of their rights regarding care, and informed to make decision related to their care in a timely manner.
Patient #2 was a 70+ year old who presented to the emergency department with a complaint of depression, anxiety, and suicidal ideation. Patient #2 was admitted for inpatient care on a voluntary status. Review of patient #2's open medical record, including the electronic version and the physical chart, revealed all consents except one, the voluntary admission form, were signed 30 days post admission. These consents, signed on the 31 day of admission, included those of financial, treatment, and rights notification. The hospital failed to provide evidence that patient #2 was informed of rights and care options by way of the hospital's standard notices, forms, or consents that are generally presented to patients on admission. There was no indication in the medical record that the patient lacked capacity or inability to sign consents related to patient #2's hospitalization as the patient was document as alert and oriented throughout this admission.
PATIENT RIGHTS: RESTRAINT OR SECLUSION
Tag No.: A0168
Based on the review of 5 open medical records and 5 closed medical records, inclusive of two violent restraint records, it was determined the hospital failed to obtain an order for violent restraints for patient #10.
Patient #10 was a 25+ year old who was brought to the hospital's emergency department (ED) as an emergency petition via police for threatening behavior. On the second day of patient #10's ED stay, patient required 4 point (limb) violent restraints for violent and threatening behavior. While there were two orders found for "short term restraint/physical hold," an order for 4 point violent restraints was not found. Patient #10 was placed in 4 point restraints around 12:30 and was released at 13:14. Therefore, patient was mechanically restrained for 45 minutes without an appropriate order.