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Based on record review, policy review and staff interview, the facility failed to ensure safety met the needs of one (#9) of ten sampled patients in the Emergency Department (ED).

Findings include:

Patient #9's Assessment Data dated 3/27/14 at 5:32 p.m. and signed by the ED RN indicated safety precautions had been implemented due to the patient expressing suicidal ideation. The documentation indicated a sitter was with the patient, the patient was placed in a psychiatric safe room and the sharps box was secured. The patient was triaged at level 2.

The Certificate of Professional Initiating Involuntary Examination dated 3/27/14 at 8:00 p.m. and signed by the ED physician indicated the patient was being placed under the Baker Act. The supporting evidence indicated the patient was actively suicidal and had taken an overdose of medication.

The Emergency Provider Report dated 3/27/14 at 5:13 p.m. included documentation by the ED physician indicating at an unstated time after the patient was medically cleared, the patient obtained access to his home medications. The ED physician documented he presumed the home medications were brought in by the patient's friend. The ED physician documented the patient took about 20 or more pills of each home medications. He was admitted to MICU (Medical Intensive Care Unit).

A detailed review of the electronic medical record with the facility staff failed to reveal evidence of a nursing reassessment of the patient between the last documented entries at 7:36 p.m. and the patient's transfer to MICU at 11:07 p.m. With the exception of the ED physician documentation regarding the taking of the medications while under suicide precautions with a sitter present, there was no documentation of the time the event occurred or the names of the home medications the patient ingested.

Assessment/Reassessment, Number: 2.600.048, revised 9/17/13 was reviewed on 3/31/14. Page 21, 2) f. Emergency Department indicated patients are reassessed based on the triage priority. Nursing care is evaluated on a continual basis to determine the progress or lack of progress toward patient outcomes. Reevaluation is documented and the plan of care is revised as appropriate. Reevaluation shall include recheck of any abnormal vital signs, any change in status and that there is no change in status from any previous evaluation. The documentation included the frequency of reassessments based on the triage priority. Emergent (Priority 1-2)-ongoing reevaluations are performed as warranted by the dynamic status of the patient's response to treatment.

Safety Technician Utilization, Number 2.600.047, revised 11/2001, was reviewed on 3/31/14. The Purpose was "To provide a safe patient care environment for patient's [sic] at risk for injury to self or others, elopement or falls". Page 5, Suicide Safe Environment Readiness Checklist included documentation indicating the registered nurse must be responsible to implement the following precautions immediately. The list of precautions included if visitors are allowed they must store their belongings in lockers provided and are not allowed to give any items to the patient.

An interview was conducted with the ED Nurse Manager. In response to questions, he stated there were no lockers in which to store visitors' belongings. He indicated the ED had safes that were large enough to store visitors' belongings. He confirmed the findings there was no evidence in the medical record indicating the time the patient's visitor arrived, no indication the visitor's personal belongings were secured and no evidence the visitor was educated regarding not providing the patient with any items. He confirmed the finding the facility policies regarding patient safety and reassessment were not followed by the RN assigned to the care of patient.