HospitalInspections.org

Based on staff interview the hospital failed to maintain the privacy of patients confined in the psychiatric unit by not receiving written informed consent from the patients who were video recorded in the psychiatric unit. Findings include:

On January 29, 2014 at 0940 the Director of Security confirmed that the patients housed in the psychiatric unit, including those receiving emergency involuntary procedures, are video monitored and that the video is recorded and retained with all hospital wide video monitoring for a period of up to thirty days until the automatic re- recording cycle begins to erase existing recorded data. It was confirmed also by hospital risk management on January 29, 2014 at 1:30 PM that no written informed consent is obtained from the patients for video recording.

Based on record review, policy review, and on staff interview the facility staff failed to discontinue a seclusion event at the earliest possible time, regardless of length of time identified in the MD order for one of two (# 1) records reviewed. Findings include:

Review of record # 1 reveals that the patient was secluded at 1745 PM on October 21, 2013. Clinical documentation by the registered nurse (RN) and supported by the physician at the scene of the emergency procedure demonstrate a need to seclude the patient. Per review of the medical record, there is no clinically supportive documentation via ongoing patient assessment to continue the seclusion from 1800 PM until it was discontinued at 1845 PM. The patient is noted to be agitated and combative per documentation from the RN and per physician notation in the certificate of need from 1745 until 1800, but per RN documentation from 1800 until 1845 when the patient is released from seclusion, the patient is identified only as "calm." Per interview on January 28 and 29, 2014, the RN in charge of the seclusion stated that [ s/he] opened the seclusion door several times to ask the patient if [s/he] was ready to speak about anything but [s/he] remained non communicative and so the door was again locked each time. When inquired of where the documentation for this action was the RN confirmed that [s/he] did not document it. When the RN was asked how [s/he] determined that at 1845 the patient was ready to be discontinued from the seclusion [s/he] stated that it was not meant to be a long lasting seclusion and that [s/he] and the physician had discussed parameters for release before hand. The physician orders in the record stipulate the seclusion duration for up to four hours. The physician progress note regarding the seclusion event denotes that the physician wanted the patient to contract for his/her own safety and well-being, and or to engage the treatment team for treatment in order to be re-evaluated for release. On January 29, 2014 at 11:30 AM per telephone interview, the physician responsible for ordering the seclusion and who had noted the conditions for discontinuing the seclusion was asked why the patient was released from seclusion without ever having verbalized an intent to not harm self or not having engaged the treatment team. The physician responded by stating, "that's a good question."The physician stated that the order was for up to four hours but his/her expectation was that it would not be long and that it is at the discretion of the monitoring RN to release the patient. At the time of the patient's release from seclusion the RN was still not able to engage the patient and clearly did not get a verbal commitment from the patient who was still sitting calm on the floor as [s/he] had been doing since 1800.
Review of the Central Vermont Medical Center Policy # A-204 titled Restraints and Seclusion for Behavioral Health Patients, last reviewed and approved July 18, 2013, stipulates that the medically necessary seclusion "will be discontinued at the earliest possible time based on the determination and clinical assessment that the patient's behavior is no longer a threat to self, staff or others."