HospitalInspections.org

Based on observation, interview and medical record (MR) review, in 1 of 1 applicable MRs (Patient #2), the hospital did not effectively inform a person with limited English proficiency of their right to interpreter services. This could lead to ineffective communication between the patient/patient representative and hospital staff.

Findings include:

-- During observation on 8/18/2020 at 9:45 am, the patient registration desk in the Emergency Department (ED) waiting room lacked signage, designated by the Department of Health, regarding the availability of free language assistance services. There was no other signage at the registration desk indicating available language assistance services for patients.

-- Per interview of Patient #2 on 8/18/2020 at 10:45 am, he was not asked at time of registration whether language assistance services were needed or what language he preferred for communication. The patient speaks Arabic and limited English.

-- Per MR review, Patient #2's preferred language was documented as English and documentation indicating whether patient required interpreter was left blank.

-- During interview of Staff A, ED Nurse Manager on 8/18/2020 at 11:00 am, he/she acknowledged the above findings.

Based on document review, medical record (MR) review and interview, in 1 of 11 MRs (Patient #3), a Medical Orders For Life - Sustaining Treatment (MOLST) form was not updated per hospital policy and procedure (P&P). This lack of update could lead to a patient's wishes concerning their provision of care to not be followed.

Findings include:

-- Per review of hospital P&P titled "Medical Orders For Life - Sustaining Treatment (MOLST) Do Not Resuscitate (DNR) orders," last revised 6/2019, it indicated that on admission, a previous MOLST must be updated immediately to be consistent with the electronic order and should be filed in the advance health directive (AHD) section of the paper MR. ... once the patient is examined, the physician or nurse practitioner should update section F of the MOLST form. If no change is made, further documentation or checklist completion is not required.

-- Per MR review, Patient #3, a 70-year-old female was admitted to the hospital on 8/13/2020 and underwent abdominal surgery on 8/17/2020. The patient's MOLST form, found in the scanned documents of the electronic MR, was completed on 7/9/2019 and did not contain section F of the MOLST form; "Review and Renewal of MOLST Orders. The MOLST form indicated Patient #3 had a DNR (Do Not Resuscitate) order. On 8/11/2020 at 7:11 pm, the physician assistant entered the order "DNR/DNI (Do Not Intubate)" in the electronic MR. There was no documentation indicating that the MOLST form had been updated by the physician or nurse practitioner.

-- During interview of Staff B, Nurse Manager on 8/18/20 at 2:00 pm, he/she acknowledged the above finding and confirmed the MOLST form was not updated.