HospitalInspections.org

Based on the review of medical records, policies and procedures, and staff interview, it was determined that the hospital failed to ensure patients full understanding and participation in the planning of care for one of one non- native English speaking patients during their visit and pending transfer within the emergency department ED.

Patient #8 was a 40 +year old who presented to the emergency department complaining of abdominal and back pain. Medical record review of the initial triage information documents the patient's preferred language to be [not-English]. ED documentation from the registered nurse #1 (RN#1) lacked any indication that language interrupter services were used or even offered to Patient #8.

During observations of the ED, staff stated that mobile devices are used to address the translation/ communication needs of non-English speaking patients. On a second tour of ED, RN#1, who was caring for Patient # 8 was asked if the mobile translation device was used for patient # 8. RN #1 reported that the device was not used, since RN #1 was able to speak a little Spanish to the patient.

Based on hospital policy titled "Communication With Persons With Limited English Proficiency" effective 01/2018 only staff designated as Qualified Bilingual/ Multilingual Staff (QBMS) were authorized to perform translation service to patients. QBMS are staff members that have been designated to provide oral language assistance and have demonstrated proficiency in a language. There was not proof that RN#1 was designated as a QBMS.

In addition, review of the ED provider's note, past medical history, and physical assessment note lacked documentation of the use of translator services. Documentation in the Past Medical History section of Patient # 8 record states that "Historian" reports or denies information provided, but does not indicate if the patient or another person provided the information.

Patient # 8's condition required the consultation of surgical services. The surgical physician assistant (PA-C) examined patient # 8, reviewed medical record, and provided recommended for needed medical interventions. At the time of the surgical consult patient # 8 was in stable condition, but would require surgical intervention. Surgical consult note from the PA did document the use of translation services including the type, and identifying information of the translator. The PA-C was the only clinician that made use of, and documented, appropriate use of translator services.

The plan in the medical record indicated that if the patient remained stable there was a likelihood of patient # 8 being transferred to an outside hospital based on the patient's insurance coverage for procedure. If the patient's condition changed, the procedure would be done at this hospital. There was discussion and preparation of pending transfer plans within the medical record among clinical staff, but is unclear if this plan was communicated to the patient.

Based on a review of 2 seclusion and one restraint record, it was determined that the hospital failed to release restrained patient #4, and secluded patients #5 and #9 at the earliest possible time.

Patient #4 was admitted to the behavioral health unit (BHU) due to requiring further inpatient mental health evaluation. On day 3 of admission, patient #4 began to break and throw things on the unit. Patient #4 was placed into 4-point restraints for dangerousness to others. Review of the record indicated no 15 minute and RN hourly documentation of behaviors to justify ongoing restraint, though patient #4 was restrained for the next 8 hours until 0600 of the following morning.

Patient #5 was admitted to the BHU due to requiring further inpatient mental health evaluation. On day four of admission, patient #5 assaulted another patient and was subsequently placed into seclusion. Review of hourly nursing documentation for 4 hours revealed documented behaviors of "combative, fighting," and "Throwing objects, body excrements." In addition, it is difficult to determine how the patient was able to continue to throw things when the seclusion room contains only a mattress and there was no one present with which patient #5 could fight.

Review of a physician face to face during hour two revealed patient #5's reaction to the seclusion as "Cooperative." This meant that the physician did not find patient #5 at that time to be "combative, fighting, and throwing objects or body excrement." Review of 15 minute safety check documentation revealed attributions in each box next to "sleeping." No additional descriptive behavioral documentation was found that justified keeping patient #5 in seclusion.

Patient #9 was admitted to the behavioral health unit (BHU) due to requiring further inpatient mental health evaluation. On admission day two, patient #9 became combative with staff and patients. Patient #9 was placed into seclusion.

Review of hourly documentation over the course of 4 hours revealed ongoing behaviors of "Yelling, shouting and/or screaming." Review of a physician face to face completed within one hour of seclusion revealed the reaction to seclusion as, "Patient quiet in secluded room but still pacing and sometimes bangs on door." Review of every 15 minute "safety check" documentation revealed check marks next to "sleeping." No additional descriptive behavioral documentation was found that justified keeping patient #9 in seclusion.

In summary, restraint documentation for patient #4 and seclusion documentation of patients #5 and #9 failed to describe behaviors that justified continued restraints or seclusion, and contained contradictory information from various clinical staff, making it impossible to determine if patients # 4, #5 and #9 were released at the earliest possible time.