HospitalInspections.org

Based on interview and record review the facility failed to ensure that the parents of an adolescent patient were allowed the right to make an informed decision about treatment as evidenced by 1 (Patient #1) of 7 patients (Patient #1, #12, #13, #14, #15, #16 and #17) was given Trazodone without parental consent. Following the incident, the facility also failed to ensure adequate training of 1 (RN #66) of 2 (RN #66 and RN #67) staff nurses on the Informed Consent for Medication Administration policy.

Record review of Physician ' s Orders by MD #56 dated 11/04/2015 at 2300 revealed: Trazadone 50mg by mouth now to be given to Patient #1.

Record review of Medication Administration Record revealed Trazodone 50mg was given to Patient #1 on 11/04/2015 at 2305 by RN #69.

Record review of medical record for Patient #1 did not produce a Consent for Treatment with Psychoactive Medication form for Trazodone dated 10/29/2015 through 11/05/2015.

In an interview with DQ #52 on 07/12/2016 at 1400, she stated:
· Patient #1 complained of inability to sleep so RN #69 phoned the physician who ordered Trazodone.
· The nurse considered the one time dose of Trazodone to be an " emergency " dose so she did not phone the parents to get consent to give the psychoactive medication.
· The Trazodone was not an emergency medication.
· CNO #53 did additional education on now-dose orders and emergency medications.

In an interview with RN #66 on 07/12/2016 at 1015, she stated she would not phone the parents to get a consent to administer a one time now dose of Trazodone because the physician ordered the medication " now. " " You don ' t want to wait. Give it as soon as possible. "

Record review of Policy & Procedure, Informed Consent for Medication Administration, dated 03/15/2016 revealed: Informed Consent for the administration of psychoactive medication shall be required for all patients ... Such consent must be written and made a part of the medical record ... Informed consent must be given by the legally authorized representative of a patient under the age of 18 ... Psychoactive medications may not be administered to a patient ... without informed consent, except in an emergency. "

Based on observation, interview and record review, the facility failed to ensure that 7 (Patient #1, #2, #3, #4, #5 #6 and Patient #7) of 7 patients were protected from potential harm as evidenced by:
(1) Patient #1 stated that a male peer exposed his genitals and made sexual remarks to him on the patio area of the male adolescent unit while hospitalized 10/29/2015 - November 5, 2015.
(2) 6 (Patient #2, #3, #4, #5 #6 and Patient #7) of 6 patients were in a group room without staff supervision.

In an interview with the complainant on 07/08/2016 at 1810, he stated a peer exposed his genitals to his son, Patient #1, while on the patio area of the adolescent unit.

Observation of the male adolescent area of Unit 7 on 07/12/2016 at 1000 revealed the boys on one end of a long hallway. (The girls were on the opposite end of the hallway. The two areas were separated by double doors that were opened.) To the right of and just behind the nurse ' s station was a group room. The patients could not be observed from the nurse ' s station. RN #66, RN Orientee #67 and MHT #68 were manning the unit. Further observation from 1024 until 1026 revealed six male patients (Patient #2, #3, #4, #5 #6 and Patient #7) in the group room with no staff supervision. [The surveyor does not know how long the patients had been in the room alone prior to 1024.]

In an interview with MHT #68 on 07/12/2016 at 1026, he stated:
· He remembered Patient #1.
· Patients are allowed to go outside in the patio area.
· Staff accompanies patients to the outside patio area.
· The MHT may step back inside to allow a patient to get water.
· This would leave the patients outside without a staff member with them.

In an interview with CNO # 53 on 07/12/2016 at 1115, she stated adolescent patients are to be monitored continuously by a staff member.

Record review of Policy & Procedure, Patient Observation Rounds, dated 01/11/2016, revealed: " h. While monitoring hallways and patient care areas, ensure patients are ... not left in " treatment Areas " without direct staff supervision. "