HospitalInspections.org

Based on medical record review, document review and interview, in two (2) of sixteen (16) medical records reviewed, the hospital did not effectively implement its Observation Policy so that patients who presented to the Emergency Department (ED) with suicidal ideation were properly monitored,and that physician's orders were renewed (Patient's #2, #3).


Findings include:

During touring the Pediatric Emergency Services on 10/31/18 at approximately 12:45 PM, Staff G, Nurse Aide was observed sitting in a chair outside bays PED 6 & PED 7. Her seat was located between both bays.

During interview with Staff G at the time of observation, this Staff stated both patients were in the ED for suicide attempts and she was providing 1:1 observation for safety.

Review of MR for Patient #2: 15-year-old with history of suicide attempt was brought in by ambulance on 10/29/18 at 8:09 PM, accompanied by his mother, after he attempted to commit suicide by strangulation using an electric wire.
On 10/29/18 at 8:10 PM, the patient had a medical evaluation and the provider ordered the patient placed on 1:1 observation (Arm length). On 10/29/18 at 11:39 PM, the patient had a psychiatrist evaluation and it was determined the patient required inpatient psychiatry admission for stabilization. On 10/31/18 at 11:46 AM, the physician documented that 1:1 observation be continued as the patient posed danger to self. .

Review of MR for Patient #3: A 13-year-old with history of depression, presented in the facility's ED on 10/30/18 at 4:45 PM expressing suicide ideation. The patient had a psychiatrist evaluation on 10/30/18 at 5:52 PM. The psychiatrist determined that the patient posed a clear danger to herself and needed impatient stabilization. The patient was to remain on 1:1 observation for safety until transfer to a hospital willing to accept the patient.

Review of the "Progress Record & Behavioral Checklist" form, dated 10/31/18, noted for Patients #2 & Patient #3, from 12:30 PM -1:00 PM both patients were monitored by Staff G. On 10/31/18 from 1:30 PM -2:00PM, both patients were monitored by Staff H.

Review of facility policy titled: "Close and Constant (1:1) Observation for General Hospital Patients," revised 12/7/17 states; "the staff member assigned to Constant/One to One (1:1) observation will remain within arm's length of the patient and maintain visual contact at all times until relieved by another staff member for meal/ breaks."

The policy was not implemented as these patients were not in arm's length of the staff observing them.


During interview with Staff E, ED RN Manager, on 11/2/18 at approximately 1:00 PM, Staff E acknowledged that Staff G was not correctly monitoring the patients. She stated that Staff G was assigned to One to One observation for Patient #2 and Staff H was assigned to One to One Observation for Patient #3 but Staff H went for her break without notifying the nurse in charge.
Staff E stated that staff providing 1:1 observation did not have to be within arm's length of the patient.


Review of MR for Patient #2 noted on 10/29/18 at 8:10 PM, the patient had a medical evaluation and the provider ordered the patient placed on 1:1 observation (Arm length). The order was dated on 10/29/18 8:20 PM: Frequency: continuous x 24 hours.

There was no documentation that this order was renewed after 24 hours.

Review of facility policy titled: "Close and Constant (1:1) Observation for General Hospital Patients'" revised 12/7/17 states; "Constant / One to One (1:1) Observation requires a physician's order and the order must be renewed every 24 hours.

This policy was not implemented as there was no documented evidence that the order for 1:1 Observation was renewed.