HospitalInspections.org

Based on medical record review, interviews and document review, the Acute Care Hospital failed to honor patients right to refuse care for 1 of 1 patients (Patient #1) refusing catheterization for a urinalysis in the Emergency Department (ED).

Failure to honor patients right to refuse care offered by the hospital could potentially cause long lasting psychological harm to patients.

Findings include:

Review of the ED medical record for Patient #1 revealed patient presented to the ED on 12/11/11 with a diagnosis of suicidal attempt- overdose of Novolog insulin. The physician's orders showed an order for a clean catch urinalysis. The Intravenous (IV) Therapy/Intake document showed output from foley catheter. The medical record lacked a physician order for placement of the foley catheter.

During an interview on 2/14/12 at 7:35 A.M., Staff A Registered Nurse (RN), stated Staff D, RN asked me to assist with inserting a foley catheter in Patient #1 around 8:30 to 9:00 P.M. on 12/11/12. When entering the room, Patient #1 appeared asleep. Staff D and I attempted to remove the patient's pants, but could not do so. We attempted to roll the patient side to side to remove the pants when the patient woke up. The patient asked Staff D what was going on. Staff D told the patient he/she needed a foley catheter inserted for a urinalysis and to monitor kidney functions. The patient refused to have the foley catheter insertion. Staff D told the patient, he/she no right to refuse care because of attempt to overdose on insulin. The patient held onto the top of his/her pants and refused the catheter again. Staff A said before I knew what happened, Staff D had cut the patient's pants and inserted the catheter. Staff did not physically hold the patient down for the catheter insertion. Staff A said Staff D should not have inserted the catheter, but should have respected the patient's right to refuse care and notified the physician for further orders.

During an interview on 2/14/12 at 12:20 P.M., Physician A reported no recollection of ordering a foley catheter insertion for Patient #1's urinalysis. Physician A did not recall Staff D asking for an order for the foley catheter insertion after completion of the procedure. Physician A said Staff D should not have inserted the catheter when the patient refused the procedure, but should have reported the patient concerns and asked about the necessity of the urinalysis before proceeding with the catheter insertion. Eventually the patient might have needed a catheter for proper care, but non-emergent at that time. The patient had the right to refuse the procedure.

During an interview on 2/15/12 at 12:35 P.M., Staff B, Director of Emergency Department and Trauma Services confirmed Staff D violated the patient's right to refuse care when inserting the foley catheter against the patient's wishes. The nurse did not obtain a physician's order prior or after inserting the catheter.

Review of the hospital Patient Handbook revealed in part... " Participation in Treatment Decisions: Accept medical care or refuse treatment to the extent permitted by law, and to be informed of the medical consequences of such refusal."

The patient rights to refuse care and treatment were violated when Staff D inserted the foley catheter after the patient refused the procedure.