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Based on interviews and record review, the facility failed to ensure patients were provided hygiene care in 3 of 11 medical records reviewed (Patients #3, #7 and #8).

This failure resulted in missed patient hygiene care.

FINDINGS

POLICY

According to the facility policy, Clinical Services Documentation, in the patient record, the Director of Nursing (DON) and the Nurse Management Team is responsible to assure that a staff member documents every shift on every patient.

According to the facility policy, Bathing of Patients, patients who need assistance will have staff assist with hygiene needs as required, including the offer of a shower/bath every other day or prn if indicated.

According to the Patient Orientation literature from the admission folder, the patient is expected to shower daily.

According to the unit schedule in the admission folder and posted in each unit, hygiene break is every day at 5:15 p.m.

1. The facility failed to provide ongoing hygiene care in order to meet the basic care needs of patients.

a) A record review of Patient #7 revealed the patient was admitted to the facility for a mental health crisis to the Geri-Psych unit. From 03/14/17, the day of admission, to 03/20/17, the day of discharge; the record reflected the patient was provided only one shower. Additionally, during the 14 days, there was no evidence of oral hygiene provided.

b) A record review of Patient #8 revealed the patient was admitted on 04/11/17 to the Geri Psych unit for a mental health crisis. From 04/11/17 to 04/23/17, a total of 12 days, there was no evidence a shower or oral hygiene was provided. The record reflected Patient #8 was not cognitively able to participate in activities.

c) A review of the medical record for Patient #3 revealed the patient was admitted on 01/24/17 to the Geri Psych unit for a mental health crisis. The medical record revealed an inconsistent hygiene routine. There was no documented showers or oral hygiene from 01/31/17 to 02/11/17, a total of 10 days.

d) An interview was conducted with a Mental Health Technician (MHT #6) on 04/25/17 at 9:28 a.m. MHT #6 stated patients would be reminded to take a shower and perform oral hygiene if the patient was not showering daily. MHT #6 reported the patients would be reminded when the hygiene breaks were, to assist them in participating in hygiene activities.

Patients #3, #7 and #8's medical records showed no evidence the patients refused or were reminded to participate in hygiene activities.

e) An interview was conducted with Registered Nurse (RN) #1 on 04/27/17 at 1:14 p.m. RN #1 reported nurses performed daily assessments which included documenting if the patient completed personal hygiene and/or required encouragement with grooming each shift. S/he did not know if there was a specific policy about bathing or showers. RN #1 stated the MHT would document if the patient showered or not. S/he stated there was communication between the MHT and RN when there was a problem with the patient completing hygiene activities. If the facility had repeatedly tried to help a patient complete hygiene activities, then a behavioral plan was created for the patient to complete personal hygiene. RN #1 stated if it was not documented, then it was not done.

f) An interview was conducted with Director of Clinical Services (DCS) #5, on 04/27/17 at 11:40 a.m., who reported nurses were to perform a daily assessment that included documentation about patient hygiene activities.

g) An interview was conducted with Director of Nursing (DON) #2 on 04/27/17 at 2:21 p.m. DON #2 stated the expectation was that nurses documented showers in the 24 hour Registered Nurse assessment. DON #2 reported hygiene care should be documented daily.