HospitalInspections.org

Based on policy review, record review, and patient and staff interviews, it has been determined that the hospital failed to report an allegation of abuse made by a patient who was admitted to the hospital for 1 of 4 patients reviewed for abuse, Patient ID #1.

Findings are as follows:

According to the hospital's policy titled, "Reporting Patient to Patient and Staff to Patient Abuse" effective 4/13/2021 states in part,

"...V. Procedure.

Reporting and Investigating Staff-to-Patient Abuse

1) Any staff member or employee of the Hospital, or any person within their professional capacity, who has knowledge of, or reasonable cause to suspect patient abuse, neglect or mistreatment shall immediately report his or her concerns..."

Record review of an "Initial Psychiatric Evaluation" upon admission to the hospital in October 2022 revealed that Patient ID #1 was seen by social services after stating she/he was abused by staff at his/her nursing home.

Further review of the "Initial Psychiatric Evaluation" revealed that the patient reported she/he was at the hospital to have his/her arms examined since "...a woman who works in the pharmacy at [his/her] nursing home is punching [his/her] arms and deliberately bumped into [him/her] one time..."

Additional review of the "Initial Psychiatric Evaluation" revealed that the patient expressed she/he did not want to return to his/her nursing home because she/he did not feel safe there.

During a surveyor interview on 10/31/2022 at 11:50 AM with Patient ID #1 in the presence of the Nursing Director of the Geriatric Unit, she/he revealed that approximately 2 to 3 weeks ago, a red-haired female nurse who is also the pharmacist at his/her nursing home punched his/her arms with closed fists leaving marks. She/he indicated she/he told staff at the nursing home to call the police because she/he was "being beaten." Additionally, the patient indicated that this nurse would bump him/her with her bottom.

During a surveyor interview on 10/31/2022 at 12:08 PM with the Nursing Director of the Geriatric Unit, she acknowledged and indicated that she, along with other hospital staff, as well as the patient's nursing home, are all aware of the allegations made by this patient.

During a surveyor interview on 10/31/2022 at 1:00 PM with the Director of Risk Management, she revealed that the allegation of abuse made by Patient ID #1 upon admission was not reported to the hospital's internal reporting system nor to the Rhode Island Department of Health.

Based on policy review, record review, and staff interview, it has been determined that the hospital failed to ensure that employees are trained in the application of restraints prior to the application of a physical restraint and annually per hospital policy for 3 of 12 employees reviewed, Employees A, B, and C.

Findings are as follows:

The hospital's policy for "Restraint and Seclusion" effective 9/17/2019 states in part,

"I. Purpose. The purpose of this Restraint and Seclusion policy... is to assure the safety of patients and staff, and to ensure compliance with all applicable regulations, when restraint and seclusion become necessary during patient care...

...Training of Staff:

All nursing and security staff is required to attend education and training, which emphasizes de-escalation techniques and the safe use of restraint and seclusion procedures and to demonstrate competence in these techniques and procedures (as well as the hospital's policies and procedures relating to restraint and seclusion) during orientation before they participate in any use of restraint or seclusion and annually thereafter..."

1. Record review revealed that on 10/1/2022 at 9:15 AM, a physical restraint was applied to a patient for 4 to 5 minutes. Employee A, Mental Health Worker/Nursing Assistant, held the patient's left arm.

Review of Employee A's education record from 9/1/2021 through 10/31/2022, failed to reveal evidence that education and training regarding de-escalation techniques and the safe use of restraint and seclusion procedures were completed prior to participating in the above-mentioned physical restraint.

2. Record review revealed that on 10/11/2022 at 4:40 AM, a physical restraint was applied to a patient for 10 minutes. Employee B, Mental Health Worker/Nursing Assistant, participated in this restraint and was positioned at the patient's head.

Review of Employee B's education record from 9/1/2021 through 10/31/2022, failed to reveal evidence that education and training regarding de-escalation techniques and the safe use of restraint and seclusion procedures were completed prior to participating in the above-mentioned physical restraint.

3. Record review of Employee B's education record from 9/1/2021 through 10/31/2022, revealed that education and training regarding de-escalation techniques and the safe use of restraint and seclusion procedures were last completed on 9/21/2021. The record failed to reveal that this training was completed annually thereafter.

During a surveyor interview on 10/31/2022 at approximately 3:15 PM with the Director of Risk Management and the Director of Nursing Education, they were unable to provide evidence that Employees A, B, and C, completed education and training that emphasizes de-escalation techniques and the safe use of restraint and seclusion procedures per hospital policy.