HospitalInspections.org

Based on record review and interview, the facility failed to develop treatment plans that identified nursing and social work interventions to address the specific treatment needs of eight (8) of eight (8) sample patients (A1, B1, C6, D24, E16, E22, F6 and F10). Instead, many of the interventions identified in the treatment plans were routine, generic discipline functions that lacked focus for treatment. This resulted in treatment plans that failed to reflect a comprehensive, integrated, individualized approach to multidisciplinary treatment.

Findings include:

A. Treatment Plan Review:

1. Patient A1-Treatment plan dated 2/17/16

For the problem stated as "Pt. was depressed and suicidal and overdose on her/him medications and set arson to her apartment," the only nursing intervention was stated as, "Will meet with (name of the patient) on a weekly basis for at least ten minutes to encourage her to actively participate in discharge planning and resolving legal issues." There were no specific nursing interventions to address the patient's depression and suicidal behaviors.

The only social worker intervention was a task/job related statement listed as "Social worker will meet with Pt (Patient) 15 minutes weekly to discuss discharge planning."

2. Patient B1-Treatment Plan dated 3/2 16

For the problem stated as "(patient name) was feeling depressed and suicidal with multiple suicide attempts." The only nursing intervention was stated as, "Primary and secondary advocates will meet with (name of the patient) a minimum of three (3) times weekly to provide positive interaction and encourage effective coping with daily stressors." There is no intervention to address the patient's depression and suicide behaviors."

The only social worker intervention was a generic statement listed as "Social worker will meet with Pt (Patient) 15 minutes weekly to discuss identifying coping skills to reframe (illegible word) from self- harm behaviors."

3. Patient C6-Treatment plan dated 2/17/16

For problem stated as "not taking medications as prescribed...disorganized thinking with a belief that (s/he) was being attacked and poor self care," the only nursing intervention was a generic function stated as "Pt (Patient) will meet c/ (with) pt advocates 3x wk (week) for 10-15 minutes to become familiar c/ unit routine/rules and participate in treatment plans." There were no specific nursing interventions to address the patient's psychotic behaviors in the clinical area.

The only social worker intervention was a generic statement listed as "Social worker will meet with Pt (Patient) 15 minutes weekly to discuss participating in ward (illegible word) and treatment."

4. Patient D24-Treatment plan dated 2/9/16

For problem stated as "not taking (his/her) medications as prescribed, likely contributing to religious and bizarre delusions, paranoia, suspiciousness and threatening behavior," there were no specific nursing interventions to address the patient's psychotic and threatening behaviors in the clinical area.

5. Patient E16-Treatment plan dated 3/8/16

For the problem stated as "(patient's name) was transferred from Venango county jail where he was awaiting trial for drug possession for further stabilization for psychiatric symptoms including paranoia and disorganizing thinking." The only social worker intervention was a generic statement listed as "Social worker will meet with (patient's name) for a minimum of 15 minutes weekly to assess behaviors and provide social casework services."

6. Patient E22-Treatment plan dated 2/26/16

For the problem stated as, "(patient ' s name) was agitated and angry and broke the door to his psychiatrist's office, secondary to delusions." The only nursing intervention was a generic function stated as, "Nursing staff and advocate will meet with (patient's name) 3 x (times) wk. (week) 5 - 10 minutes to provide support, encourage cooperation with treatment." "Monitor provide support." There were no specific nursing interventions to address the patient's aggressive behavior.

The only social worker intervention was a generic statement listed as "Social worker will meet with (Patient's name) for a minimum of 15 minutes weekly to discuss coping skills and importance of following ward rules."



7. Patient F6-Treatment plan dated 2/23/16

For problem stated as "...non compliance and related mood instability leading to verbally threatening or physically aggressive behaviors," the only nursing intervention was a generic function stated as "Advocates will meet with (patient) 2-3 times weekly for 10-15 minutes to discuss current goal and any other issues." There were no specific nursing interventions to address the patient ' s aggressive behavior in the clinical area.

The only social worker intervention was a generic statement listed as "Social worker will meet with (Patient) 10-15 minutes weekly to discuss social casework needs and encourage (him/her) to verbalized how (s/he) uses coping skills."

8. Patient F10-Treatment plan dated 3/1/16

For problem stated as, "internally preoccupied with anxious and angry affect, often observed pacing the halls, yelling at unseen others, hitting himself on the chest and forehead, engaging in bizarre behaviors and has had a number of AWOL attempts over the past year," there were no specific nursing interventions to address the patient's psychotic behavior in the clinical area or Patient F10's attempts to escape from the unit.

The only social worker intervention was a generic statement listed as "Social worker will meet with (Patient) for a minimum of 15 minutes weekly to encourage regular ADLs (Activities of Daily Living)."


B. Interviews

1. During interview with review of treatment plans on 3/15/16 at 10:00 a.m., RN 3 stated, "We must focus (interventions) on the problem--why the patient is here."

2.During interview with review of treatment plans on 3/15/16 at 10:35 a.m., the Chief of Social Rehabilitation acknowledged that many of the social work interventions were generic statements.

3. During interview with review of social work interventions on the treatment plans, the Director of Social Work stated, "The methods (interventions) must specifically relate to the problem and goal. I definitely see where you are coming from (when talking about generic interventions)."

4. During an interview on 3/15/16 at 2:30 p.m., RN 6 stated "yes, interventions should be specific and related to the problem." RN Nurse Supervisor 3 stated "this is an easy fix, we will provide more training."