HospitalInspections.org

Based on record review and interview the facility failed to notify the patient's guardian of admission and discharge to the emergency department for 3 of 6 patients with guardians, out of a total universe of 11 records reviewed.

Findings Include:

Record review of facility policy, titled, Patient Consent, written 10/10/2018, revealed, "If an adult patient lacks decisional capacity or has been declared legally incompetent, he/she may not provide informed consent or sign an informed consent form. With respect to such patients, the provider must obtain informed consent and/or signature, as required, from either of the following if available: i. The patient's legal guardian or other authorized legal representative."

Review of facility new employee orientation slides on 11/10/2021 at 11:10 AM with Human Resources Staff T, revealed, "Patient & Resident Rights, Except in emergencies, the consent of the patient or the patient's legally authorized representative (Guardian or Activated POA) (Power of Attorney) shall be obtained before treatment is administered."

In an interview with ED (Emergency department) Manager O on 11/09/2021 at 1:20 PM when asked what is the expectation when someone has a guardian, stated, "If they come from the facility we make sure it's okay and then keep them involved in the whole process, sometimes the MD talks to them."

In an interview with ED manager O on 11/09/2021 at 1:20 PM when asked how do you know if a patient has a guardian, stated, "It depends, if the nursing home is sending them, they tell us or sometimes there is paperwork or it could be later, after digging in the chart." ED manager O said there is a yellow banner in the chart that lists when a patient has a guardianship.

In an interview with ED RN N on 11/10/2021 at 9:00 AM when asked what is the expectation when someone has a guardian, stated, "Has the guardian been called, the facility will tell us yes or no, we need to have permission and then attempt to call them. We document attempts in the notes, we update the guardian that the patient is here and update on care and why they are brought in and what the plan is and to find out history."

In an interview with ED RN N on 11/10/2021 at 9:00 AM when asked how do you know if a patient has a guardian stated, "If they come from a nursing home or CBRF (Community Based Residential Facility) we get report, if a vulnerable adult, elderly or history of dementia we ask, or in the record or it is located in the yellow banner in the chart."

In an interview with Staff B during record review of Pt. #2 record on 11/10/2021 at 9:55 AM when asked if could find evidence of notification of the guardian, stated, "I don't see that there is documentation of a conversation with the guardian." When asked how could she/he sign her consent to treat when she/he has an activated guardian, stated, "She cannot consent to treat."

In an interview with Educator Staff S on 11/10/2021 at 11:05 AM when asked what education is provided to staff regarding guardianship stated, "There is no specific education on guardianship done on a yearly basis, just new employee orientation."

Review of Pt. #2 record revealed that patient had a legal guardian for person and estate. A consent for treatment is signed by Pt. #2.

Review of Pt. #3 record revealed that a legal guardian was listed on the banner in the chart. Pt. # 3 had a diagnosis of advanced dementia and was unable to provide any information. No evidence of documentation present about notification of the guardian or the facility to obtain additional information and to clarify guardianship status.

Review of Pt. #4 record revealed that patient had a legal guardian for person and estate. Guardian contact information is in the medical record. No documentation present indicating communication with the legal guardian.

These findings were discussed with and confirmed during record review with Staff B and Staff R on 11/10/2021.