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Based on record review and interview the hospital failed to follow the hospital Complaint/Grievance policy and ensure grievances were investigated, reports were written, and grievance decisions were provided in writing to Patient #5.

Review of policy titled Occurrences/Complaints presented as current grievance policy revealed, in part, the purpose is to provide a mechanism which identifies and addresses all patient/visitor complaints in a timely and efficient manner; to ensure all complaints are reviewed/investigated, tracked, and trended; and every complaint is reviewed by the appropriate person, responded to on an individual basis and that feedback and appeal mechanism is available to the complainant.
If the complaint presents apparent issues of legal liability and or media involvement, the Compliance Officer shall contact the Hospital Administration.
Clinical Complaints shall be reviewed by the DON for purposes of risk assessment, need for urgent intervention, need for physician review, administrative awareness of issues pending investigation for appropriate routing and follow up.
All Directors and Department Supervisors must compete any investigational reports and disciplinary action forms. These reports must be received by the Compliance Officer within ten (10) working days of the original occurrence or complaint.
Upon resolution, and within sixty (60) days, the individual filing the complaint shall be sent a follow-up letter from the Compliance Officer, or designee. The letter shall outline the investigative steps taken, the results, and the date of completion of investigation, and the name of the Franklin Medical Center contact person for further communication if necessary.

Patient #5
On 12/05/18 review of Patient #5's electronic medical record with the guidance of S3RN revealed Patient #5 is a 41 year old who presented to the ED department on 09/21/18 with a chief complaint of painful urination, headache for three days, abdominal pain and nausea with vomiting. She was triaged at 2:11 a.m. by S5RN. S8MD documented a physical assessment at 2:29 a.m. Patient #5 was discharged to home at 3:05 a.m. by S6LPN following a Toradol (nonsteroidal anti-inflammatory drug) injection and vital signs were taken. She was discharged with three prescriptions (an antibiotic for UTI, anti-nausa and vomiting medication, and a pain medication for the headache).

Review of the complaint for Patient #5 revealed an investigation was initiated. There is no documentation of staff interviews of the staff (S5RN, S6LPN, S8MD) addressed in the complaint. There is no investigational report. The complainant was not sent a follow-up letter which outlined the investigative steps taken, the results, and the date of completion of investigation, and the name of the Franklin Medical Center contact person for further communication if necessary.

On 12/06/16 at 5:15 a.m. in an interview with S5RN revealed his only recollection of Patient #5's ED visit on 09/21/18 was her vital signs were fine and he put her in a room. Further interview revealed he did not recall S3RN or S4RN interview him regarding Patient #5's ED visit on 9/21/18.

On 12/06/18 at 5:30 a.m. in an interview with S6LPN revealed his only recollection of Patient #5's ED visit on 09/21/18 was he gave her a shot of Toradol and did her vital signs. Further interview revealed he did not recall S3RN or S4RN interview him regarding Patient #5's ED visit on 09/21/18.

On 12/06/18 at 9:25 a.m. in an interview with S3RN revealed there was no final resolution regarding Patient #5's grievance and he discontinued the investigation on 10/23/18 when Patient #5 instructed him she retained an attorney.

On 12/06/18 at 10:00 a.m. in an interview with S4RN revealed he spoke with S5RN and S6LPN who denied any negative conversations or confrontations with Patient #5 regarding her ED visit with S5RN nor S8MD on 09/21/18. S4RN stated he did not document the above interviews. S4RN stated the procedure is to report his findings to S3RN and he documents the information.

Based on record review, observation and interview, the hospital failed to ensure patients received care in a safe setting. This deficient practice was evidenced by failing to ensure the psychiatric patients who were held in the ED seclusion room and assessed to be a harm to themselves' physical environment was maintained in a manner to assure an acceptable level of safety as evidenced by failing to ensure there are no ligature risks in the seclusion room.

Review of the hospital's policies and procedures revealed no policy for seclusion, suicide precautions or elopement precautions.

On 12/05/18 at 10:25 a.m. a tour of the ED with S4RN revealed one secure holding room he said was for PEC patients. The seclusion room contained a door which locked from the outside. Inside the seclusion room was a long red cord attached to the emergency call bell on the wall.

On 12/05/18 at 10:30 a.m. S4RN verified the seclusion room which locks from the outside was a room designated for PEC patients. He further verified the long cord which was securely attached to the wall was a ligature risk.

39791


Based on record review and interview, the hospital failed to ensure locked seclusion was used for the management of violent or self-destructive behavior. This deficient practice was evidenced by placing 2 (#21, #22) of 2 sampled psychiatric ED patients in locked seclusion while they were not exhibiting violent or self-destructive behaviors that jeopardized the immediate physical safety of the patient, the staff member or others.

Findings:

Review of the hospital's policies and procedures revealed no policy for seclusion, suicide precautions or elopement precautions.

Observation of PEC 1 room revealed a dedicated room safe for psychiatric patients. The room had 1 door that could be locked from the outside.

Review of Patient #21's medical record revealed he had arrived to the ED with a chief complaint of hallucinations. He had arrived on 11/7/18 at 8:52 a.m. and was transferred to a psychiatric facility on 11/7/18 at 6:30 p.m. (9 hours and 38 minutes). He had been issued a PEC on 11/7/18 at 2:20 p.m. Further review revealed he was placed in PEC 1 room. There was no documentation of the patient exhibiting self-destructive or violent behaviors or documentation of a physician's order for seclusion.

Review of Patient #22's medical record revealed she had arrived to the ED with the chief complaint of suicidal ideations. She had been triaged at the ED on 11/11/18 at 4:23 p.m. and transferred to a psychiatric facility on 11/11/18 at 9:16 p.m. (6 hours and 53 minutes). Patient #22 had been issued a PEC on 11/11/18 at 5:30 p.m. Further review revealed she was placed in PEC 1 room. There was no documented physician's orders for seclusion or documentation of the patient exhibiting violent or self-destructive behaviors.

In an interview on 12/5/18 at 2:50 p.m. with S4RN, he said he was the ED Director. S4RN verified Patient #21 and Patient #22 did not have orders for seclusion. He said if a patient was issued a PEC and the PEC 1 room was available, the patient was placed into the room, the door was locked and the patient was observed by a camera that was viewed from a computer screen at the nurse's station. When asked why a staff member is not sitting with the patients instead of locking them in seclusion, he said they do not have the staff to sit with patients. He said they never know when they are going to get a psychiatric patient so they can't staff for them. When asked if every PECd patient needed to be in locked seclusion, S4RN said that is just what they are in the practice of doing at the hospital.

In an interview on 12/5/18 at 3:40 p.m. with S7MD, he said the ED physicians do not have an order option in the computer charting system for placing a patient in seclusion. When asked why a staff member is not used instead of locked seclusion, he said they did not have the staff.

In an interview on 12/5/18 at 4:00 p.m. with S9RN, she said she worked in the ED. She said almost every psychiatric patient that is placed into PEC 1 has the door locked. She said if it is a child she would not lock the door or sometimes she felt sorry for people and would leave the door unlocked. She said the patients assumed it was locked anyway so it was usually not a problem. She said it was an "understanding" to place the psychiatric patients into PEC 1 and lock the door. S9RN verified there were never physician's orders for placing a patient into seclusion.

In an interview on 12/6/18 at 10:00 a.m. with S4RN, he said the hospital did not have policies or procedures for suicide risk precautions, elopement risk precautions or seclusion.

39791


Based on record review and interview, the hospital failed to ensure less restrictive interventions were attempted before placing patients into locked seclusion for 2 (#21, #2) of 2 sampled psychiatric ED patients placed in seclusion.

Findings:

Review of the hospital's policies and procedures revealed no policy for seclusion.

Observation of PEC 1 room revealed a dedicated room safe for psychiatric patients. The room had 1 door that could be locked from the outside.

Review of Patient #21's medical record revealed he had arrived to the ED with a chief complaint of hallucinations. He had arrived on 11/7/18 at 8:52 a.m. and was transferred to a psychiatric facility on 11/7/18 at 6:30 p.m. (9 hours and 38 minutes). He had been issued a PEC on 11/7/18 at 2:20 p.m. Further review revealed he was placed in PEC 1 room. There was no documentation of less restrictive interventions being used before placing Patient #21 in locked seclusion.

Review of Patient #22's medical record revealed she had arrived to the ED with the chief complaint of suicidal ideations. She had been triaged at the ED on 11/11/18 at 4:23 p.m. and transferred to a psychiatric facility on 11/11/18 at 9:16 p.m. (6 hours and 53 minutes). Patient #22 had been issued a PEC on 11/11/18 at 5:30 p.m. Further review revealed she was placed in PEC 1 room. There was no documented evidence of less restrictive interventions being used before placing Patient #22 in locked seclusion.

In an interview on 12/5/18 at 2:50 p.m. with S4RN, he said he was the ED Director. S4RN verified Patient #21 and Patient #22 did not have less restrictive interventions documented before they were placed in a locked room. He said if a patient was issued a PEC and PEC 1 room was available, the patient was placed into the room, the door was locked and the patient was observed by a camera that was viewed from a computer screen at the nurse's station. When asked if every PECd patient needed to be in locked seclusion, S4RN said that is just what they are in the practice of doing at the hospital.

39791


Based on record review and interview, the hospital failed to ensure the use of restraint or seclusion was in accordance with the order of a physician or other licensed independent practitioner who was responsible for the care of the patient and authorized to order restraint or seclusion by hospital policy in accordance with State law. This deficient practice is evidenced by 2 (#21, #22) of 2 psychiatric ED patients sampled being placed in locked seclusion with no physician's order.

Findings:

Review of the hospital's policies and procedures revealed no policy for seclusion.

Observation of PEC 1 room revealed a dedicated room safe for psychiatric patients. The room had 1 door that could be locked from the outside.

Review of Patient #21's medical record revealed he had arrived to the ED with a chief complaint of hallucinations. He had arrived on 11/7/18 at 8:52 a.m. and was transferred to a psychiatric facility on 11/7/18 at 6:30 p.m. (9 hours and 38 minutes). He had been issued a PEC on 11/7/18 at 2:20 p.m. Further review revealed he was placed in PEC 1 room. There was no documentation of a physician's order for seclusion.

Review of Patient #22's medical record revealed she had arrived to the ED with the chief complaint of suicidal ideations. She had been triaged at the ED on 11/11/18 at 4:23 p.m. and transferred to a psychiatric facility on 11/11/18 at 9:16 p.m. (6 hours and 53 minutes). Patient #22 had been issued a PEC on 11/11/18 at 5:30 p.m. Further review revealed she was placed in PEC 1 room. There was no documented physician's orders for seclusion.

In an interview on 12/5/18 at 2:50 p.m. with S4RN, he said he was the ED Director. He said if a patient was issued a PEC and the PEC 1 room was available, the patient was placed into the room, the door was locked and the patient was observed by a camera that was viewed from a computer screen at the nurse's station. S4RN verified Patient #21 and Patient #22 did not have orders for seclusion but were placed into a locked room.

In an interview on 12/5/18 at 3:40 p.m. with S7MD, he said the ED physicians do not have an order option in the computer charting system for placing a patient in seclusion.

In an interview on 12/5/18 at 4:00 p.m. with S9RN, she said she worked in the ED. S9RN verified there were never physician's orders for placing a patient into seclusion in the ED.

39791


Based on record review and interview, the hospital failed to ensure seclusion was discontinued at the earliest possible time. This deficient practice is evidenced by 2 (#21, #22) of 2 sampled psychiatric ED patients that presented with psychiatric problems being placed into locked seclusion and not being released despite no documented behaviors of being a threat to themselves, staff members or others.

Findings:

Review of the hospital's policies and procedures revealed no policy for seclusion.

Observation of PEC 1 room revealed a dedicated room safe for psychiatric patients. The room had 1 door that could be locked from the outside.

Review of Patient #21's medical record revealed he had arrived to the ED with a chief complaint of hallucinations. He had arrived on 11/7/18 at 8:52 a.m. and was transferred to a psychiatric facility on 11/7/18 at 6:30 p.m. (9 hours and 38 minutes). He had been issued a PEC on 11/7/18 at 2:20 p.m. Further review revealed he was placed in PEC 1 room. There was no documentation of the patient exhibiting self-destructive or violent behaviors or documentation of Patient #21 being removed from PEC 1 until being transferred.

Review of Patient #22's medical record revealed she had arrived to the ED with the chief complaint of suicidal ideations. She had been triaged at the ED on 11/11/18 at 4:23 p.m. and transferred to a psychiatric facility on 11/11/18 at 9:16 p.m. (6 hours and 53 minutes). Patient #22 had been issued a PEC on 11/11/18 at 5:30 p.m. Further review revealed she was placed in PEC 1 room. There was no documentationof the patient exhibiting violent or self-destructive behaviors or documentation of Patient #22 being removed from PEC 1 until being transferred.

In an interview on 12/5/18 at 2:50 p.m. with S4RN, he said he was the ED Director. S4RN verified Patient #21 and Patient #22 were in PEC 1 so the door would haave been locked. He said if a patient was issued a PEC and the PEC 1 room was available, the patient was placed into the room, the door was locked and the patient was observed by a camera that was viewed from a computer screen at the nurse's station.When asked if every PECd patient needed to be in locked seclusion, S4RN said that is just what they are in the practice of doing at the hospital. S4RN verified the psychiatric patients in PEC 1 would be locked in the room from when they were admitted until they were transferred except when they were taken to the restroom.

Based on interview, the hospital failed to ensure Emergency Department (ED) direct care staff received the education, training and demonstrated knowledge in the use of non-physical intervention skills.

Recertification survey on 04/25/18 ED revealed in part, direct patient care staff are not trained in the use of non-physical interventions.

On 12/05/18 at 4:00 p.m. in an interview with S7MD revealed is not aware of the staff having training on non-physical intervention skills.

On 12/06/18 at 9:25 a.m. in an interview with S3RN revealed there is no documentation the staff is trained the use of non-physical interventions. He further verified the recertification survey 04/25/18 revealed the ED staff was not trained in the use of non-physical interventions.

On 12/06/18 at 10:00 a.m. in an interview with S4RN, he stated he could not locate any documentation of training for ED staff regarding non-physical intervention skills. He further verified the recertification survey 04/25/18 revealed the ED staff was not trained in the use of non-physical interventions.

On 12/06/18 at 10:20 a.m. S1Admin confirmed the survey conducted on 04/25/18 revealed the ED staff was not trained in the use of non-physical interventions.

Based on observation and interview, the hospital failed to ensure all equipment was maintained in a manner to ensure an acceptable level of safety and/or quality as evidenced by failing to ensure the functionality of a nurse call button (a red "cross" symbol) located on the handrails of the beds on all patient beds.

Findings:

Observation on 12/6/18 at 10:10 a.m. of Patient rooms 308, 314, 315 and 318 with S4RN revealed the nurse call feature on the handrails of the beds were not functional.

In an interview on 12/6/18 with S1Adm, he verified the non-functioning call features on the handrails was written on a previous survey by the Health Standerds Section of the Louisiana Department of Health in April 2018. He said none of the inpatient beds had functioning call features. He said they had purchased something to cover the feature so it was not an option, but they had not been put into place as of yet.