HospitalInspections.org

Based on interview and record review, the facility failed to allow an end-of-life patient an end-of-life visit, for one patient (Patient 9), in accordance with the facility's policies and procedures.

This failure resulted in Patient 9 expiring in the hospital, after a 12 day stay, with no family visit. This failure has the potential to affect a patient's psychosocial wellbeing.

Findings:

Patient 9's Palliative Physician Note dated January 31, 2022, at 2:35 p.m., indicates, "...They wish to visit their mother. I explained patient is unlikely to leave the hospital alive in lieu of worsening acute respiratory failure without intubation..."

Patient 9's Palliative Nurses Note dated January 31, 2022, at 2:47 p.m., indicates, "...Daughter is requesting visitation (deferred to Intensive Care Unit/ICU charge nurse..." (there was no documented evidence the palliative nurse endorsed daughter's request for visit to ICU charge nurse)

On February 8, 2023, at 11:35 a.m., an interview with the Infection Control Director (ICD) was conducted. The ICD stated that per the facility's policy for January and February 2022, Patient 9 should have been allowed family visits due to being end-of-life and imminent death.

On February 8, 2023, at 11:16 a.m., an interview with the Palliative Care Chief Physician (PCCP) was conducted. The PCCP stated palliative does not arrange visits however Patient 9 should have been allowed family visits per the facility's policy for that time frame.

On February 8, 2023, from 10:00 a.m. to 11:30 a.m., a record review of Patient 9's medical record was conducted with Registered Nurse (RN) 1. A concurrent interview was conducted with RN 1. RN 1 stated there was no documentation in Patient 9's medical record indicating any family visits.

The facility's Hospital Entry Log dated January 27, 2022, through February 4, 2022, was reviewed and did not indicate any visitors for Patient 9.

The facility's Hospital Visitor Policy, revised January 12, 2022, indicates, "...No visitors are allowed unless the patient meets one of the following categories outlined below. Only then will one visitor be allowed per patient...Patients at End of Life...In cases where death of a patient is imminent. In these circumstances, one visitor at a time will be allowed to visit without the screening..."

The facility's End of Life, Care of the Patient Policy, reviewed May 2020, indicates, "Purpose: To recognize the unique and individual needs of these patients and their families and ensure respectful, responsive care of the patient in the end-of-life stages and support the family through the patient's death and bereavement...Support open visitation to accommodate patient and family needs..."