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BEHAVIORAL HOSPITAL OF BELLAIRE
PLAN INCLUDES SPECIFIC TREATMENT MODALITIES UTILIZED
Tag No.: B0122
Based upon record review and interview, the facility failed to ensure the treatment plan of 16 of 16 patients (#1-#16) contained treatment interventions of the prescribed medication and the symptoms to be addressed.
Review of treatment plans for patients #1 - #16 revealed the treatment plan was a pre-printed form that listed the drug classification (ie: Antipsychotic, Antidepressant, Detoxification Medications) to be given at the dosage prescribed to relieve whatever the medication was to relieve (ie: depression, altered thoughts, etc).
Review of the facility policy titled "Treatment Planning" revealed no procedure for what information should be contained in the Treatment Plan.
An interview was conducted with the Nurse Educator on 4/20/2012 at 11:00 am. The Nurse Educator confirmed the treatment plans did not contain the specific prescribed medication and the specific symptoms the medication was prescribed to relieve.