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The CAH (Critical Access Hospital) reported a census of 3 patients (one acute inpatient and two Swing Bed patients). The sample size for the Swing Bed review consisted of the two active Swing Bed patients and three closed Swing Bed patients. Based on record review, document review and staff interview the CAH failed to complete the activity assessment on 1 of 5 Swing Bed patients reviewed (#19) and failed to document activities provided to 2 of 5 Swing Bed patients reviewed (#19 and 20).

Findings include:

- Patient #19 admitted to the Swing Bed program on 5/4/12 and discharged to home on 5/14/12. Record review on 6/12/12 at 10:30am revealed the CAH lacked documentation they conducted comprehensive activity assessment or provided any activities for patient #19.

Patient #20 admitted to the Swing Bed program on 3/31/12 and discharged to home on 4/24/12. Record review on 6/12/12 at 11:00am revealed the CAH lacked documentation they provided activities of interest to patient #20 per the Activity assessment.

CAH Swing Bed policy titled "Activities Program directed staff "...An initial assessment of each patient's recreational and social needs will be made upon admission to the Swingbed Program. This assessment will include an outline of the patient's needs, abilities and interests...The Activity Flow Sheet is completed on each shift by the nursing staff. The Activity Flow Sheet is used to document activities that are completed throughout the day..."

Staff A, RN/CNE (Registered Nurse/Chief Nursing Executive) interviewed on 6/12/12 at 2:40pm verified activity staff failed to complete the activity assessment on patient #19 and staff failed to document activities provided to patients #19 and 20.

The CAH (Critical Access Hospital) reported a census of 3 patients (one acute inpatient and two Swing Bed patients). The sample size for the Swing Bed review consisted of the two active Swing Bed patients and three closed Swing Bed patients. Based on record review, document review and staff interview the CAH lacked documentation they included the patient and the patient's family or representative in the development or review of the patient's plan of care.

Findings include:

- Patient #16 admitted to the Swing Bed program on 5/4/12 for continued therapy and care status post a left hip replacement. Record review on 6/11/12 at 10:00am revealed the CAH lacked documentation they included the patient or their family/representative in the development or review of patient's plan of care.

Patient #17 admitted to the Swing Bed program on 5/3/12 for continued wound care. Record review on 6/11/12 at 11:00am revealed the CAH lacked documentation they included the patient or their family/representative in the development or review of patient's plan of care.

Patient #18 admitted to the Swing Bed program on 5/4/12 for rehabilitation after hip surgery and discharged on 5/14/12. Record review on 6/12/12 at 10:00am revealed the CAH lacked documentation they included the patient or their family/representative in the development or review of patient's plan of care during their hospital stay.

Patient #19 admitted to the Swing Bed program on 3/19/12 for continued care for contusions and fractures suffered in a motor vehicle accident. Patient #19 discharged to home on 3/30/12. Record review on 6/11/12 at 10:30am revealed the CAH lacked documentation they included the patient or their family/representative in the development or review of patient's plan of care.

Patient #20 admitted to the Swing Bed program on 3/31/12 due to weakness from metastatic breast cancer. Patient #20 discharged to home on 4/24/12. Record review on 6/11/12 at 11:00am revealed the CAH lacked documentation they included the patient or their family/representative in the development or review of patient's plan of care.

CAH policy titled "Patient Care Team Conference (Swing-Bed Meetings) reviewed on 6/13/12 at 12:00pm directed staff to "...There will be a Patient Care Team conference...Attendees: 7. Patient and/or family as desired or as appropriate..."

Staff C, Swing Bed Coordinator/Respiratory Therapist interviewed on 6/13/12 at 12:20pm shared the interdisciplinary team met twice a week on all patients. Staff C verified the team failed to include the Swing Bed patients or their families/representatives in the meetings.

Staff A, RN/CNE (Registered Nurse/Chief Nursing Executive) interviewed on 6/13/12 at 2:00pm verified the CAH failed to include and document the Swing Bed patients involvement in their plans of care.