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Based on interview and record review, the hospital failed to ensure patients were free from abuse and neglect for 2 (Pt. #4 and Pt. #5) of 5 (Pt. #1 - Pt. #5) records sampled for abuse and neglect when: 1) Pt. #4 was physically assaulted by 3 mental health technicians (S6MHT, S7MHT, S8MHT) while another mental health technician (S5MHT) failed to intervene; and,
2) Pt. #5's blood sugar was not assessed as per the physician's order or included as part of the multidisciplinary treatment plan.
Findings:

Patient #4
1) Pt. #4 was physically assaulted by 3 mental health technicians (S6MHT, S7MHT, S8MHT) while another mental health technician (S5MHT) failed to intervene.

Review of Pt. #4's medical record revealed an admit date of 01/18/2023 and a discharge date of 02/02/2023. Further review revealed Pt. #4's diagnosis of Schizoaffective disorder, bipolar type. Pt. #4's legal status was a coroner's emergency certificate.

Review of the medical record for Pt. #4 revealed a nursing progress note dated 02/01/2023 by S4RN which read, in part, Pt. #4 was attacked and involved in an altercation in her room.

In interview on 02/20/2023 at 2:45 p.m., S4RN indicated she witnessed in Pt. #4's assigned room, S8MHT repeatedly striking Pt. #4 in the abdomen. S4RN recalled S6MHT and S7MHT holding the hands of Pt. #4 while S8MHT struck the patient. S4RN also indicated S5MHT stood at the door watching the physical altercation and failed to intervene.

In an interview on 02/20/2023 at 1:20 p.m. S3RN and S4HR indicated they substantiated the allegation of abuse, terminated S5MHT, S6MHT, S7MHT, S8MHT, and reported their findings to the Louisiana Department of Health.

Patient #5
2) Pt. #5's blood sugar was not assessed as per the physician's order or included as part of the multidisciplinary treatment plan.

Review of Pt. #5's medical record revealed an admit date of 12/31/2022 and a discharge date of 01/09/2023. Further review revealed Pt. #5 was diagnosed, in part, with Dementia with behavioral disturbances and Diabetes Mellitus, Type 2.

Review of Pt. #5's medical record revealed a physician's order dated 01/02/2023 at 8:49 a.m. for accuchecks before meals and at bedtime.

Review of Pt. #5's Medication Administration Record (MAR) revealed no accuchecks on the day or night shifts of 01/03/2023, 01/04/2023, 01/05/2023, 01/06/2023, 01/07/2023, 01/08/2023 or 01/09/2023.

Review of Pt. #5's Treatment Plan revealed a problem documented as Alteration in Health related to Blood Sugar. Further review of the treatment plan revealed no long term goals or interventions by discipline documented on the treatment plan.

In an interview on 02/22/2023 at 2:03 p.m. S1RN verified there were no blood glucose checks/accuchecks as per the physician's order on the dates as described above and the interventions related to managing diabetes mellitus were not documented on the treatment plan.

Based on record review and interview, the hospital failed to obtain a physician's order for the use of a physical hold for forced medication administration for 1 (Pt. #4) of 1 (Pt. #4) sampled records for the use of restraint.
Findings:

Review of the policy and procedure titled, "Seclusion and Restraints" revealed, in part, Physical Hold for Forced Medications: The application of force to physically hold a patient in order to administer a medication against the patient's wishes, is considered a restraint. The use of force in order to medicate a patient must have a physician's order prior to the application of restraint (use of force). If physical holding for forced medication is necessary with a violent patient, the 1-hour face-to-face evaluation requirement would also apply.

Review of Pt. #4's medical record revealed an admit date of 01/18/2023 with a primary diagnosis of Schizoaffective Disorder, bipolar type.

Review of Pt. #4's medical record revealed a nursing progress note dated 02/01/2023 at 1:45 p.m. which documented that Pt. #4 was placed in a physical hold for forced medication administration.

Review of the physician's orders revealed no order for a physical hold to administer forced medications on 01/02/2023 at 1:45 p.m..

In interview on 02/22/2023 at 2:03 p.m. S1RN verified there was no physician's order for a physical hold to administer forced medications.

Based on record review and interview, the hospital failed to implement and record ongoing assessment and monitoring of the patient's condition by a trained staff for the prevention of patient injury or death as well as ensure that the use of restraint/seclusion is discontinued at the earliest possible time for 1 (Pt. #4) of 1 (Pt. #4) sampled records reviewed for seclusion and restraint.
Findings:

Review of the hospital's policy and procedure titled, "Seclusion and Restraints" revealed, in part, the assigned staff will provide care for patient as indicated on Seclusion/Restraint Flow Sheets for time(s) indicated: Bathroom privileges as required by the patient's circumstances/physical and medical needs; An opportunity to drink water or other appropriate liquids every 2 hours or more frequently, if requested and not contraindicated; medications as ordered; An environment that is free of safety hazards, adequately ventilated with appropriate temperature and appropriately lighted.

Review of Pt. #4's medical record revealed an admit date of 01/18/2023 with a primary diagnosis of Schizoaffective Disorder, bipolar type.

Review of Pt. #4's medical record revealed a physician's order dated 02/01/2023 at 1:15 p.m. which read, seclusion for 4 hours from now due to violent behavior towards staff.

Review of Pt. #4's medical record revealed no restraint/seclusion worksheet was completed for this occurrence of seclusion as per the hospital's policy and procedure.

In an interview on 02/22/2023 at 12:55 p.m. S1RN indicated there was no restraint/seclusion flowsheet for this occurrence of seclusion non 02/01/2023 at 1:15 p.m., but there should have been.

Based on record review and interview, the hospital failed to ensure the registered nurses (RNs) were evaluating the care of each patient on an ongoing basis in accordance with accepted standards of nursing practice and hospital policy as evidenced by review of 3 (Pt. #1, Pt. #4, Pt. #5) of 5 (Pt. #1 - Pt. #5) sampled records revealed no documented evidence of ongoing nursing assessments or care provided as per the physician's orders and multidisciplinary treatment plan goals and interventions to address care.
Findings:

Review of the policy and procedure titled, "Documentation" revealed, in part the Registered Nurse (RN) documents or reviews the Licensed Practical Nurse (LPN) documentation on the Nursing Shift Assessment a minimum of once per shift. All notes must be related to the patient's problems on the treatment plan. Documents treatment plan updates on the treatment plan review form with the treatment team.

Review of the policy and procedure titled, "Treatment Planning" revealed, in part the multi-disciplinary treatment team, under the direction and supervision of the attending physician, shall develop an integrated written, comprehensive Treatment Plan with specific goals and objectives necessary to address deficits and cultivate strengths identified in the assessment. The treatment plan includes defined problems and needs, measurable goals and objectives based on assessed needs and identified by the patient, strengths and limits, frequency of care, treatment and services, facilitating factors and barriers, and transition criteria to lower levels of care.

Review of the hospital's job description for a Registered Nurse (RN) revealed, in part, the Registered Nurse assumes primary leadership accountability and responsibility for milieu management and directing patient care activities of other nursing staff. The RN assesses the patient utilizing the nursing process to formulate an individualized plan of care for each patient, implements interventions, and evaluates outcomes consistent with policy and appropriate to the current client's condition which promote, maintain and restore physical and mental health, and prevent illness. The RN is responsible for thorough, accurate reporting, and documentation of the patient's symptoms, responses, and progress.

Patient #1
Review of Pt. #1's medical record revealed an admit date of 12/27/2022 and a discharge date of 01/04/2023. Further review of the history and physical revealed Pt. #1 was diagnosed with Diabetes Mellitus.

Review of Pt. #1's treatment plan revealed no RN or MD signatures on the treatment plan and no treatment plan problem addressing Pt. #1's diagnosis of Diabetes Mellitus.

Patient #4
Review of Pt. #4's medical record revealed an admit date of 01/18/2023 and a discharge date of 02/02/2023. Further review revealed a primary diagnosis of Schizoaffective disorder, bipolar type.

Review of Pt. #4's medical record revealed no nursing progress notes for:
7;00 a.m. - 7:00 p.m. shift on 02/01/2023
7:00 p.m. - 7:00 a.m. shift on 02/01/2023
7:00 p.m. - 7:00 a.m. shift on 01/31/2023
7:00 p.m. - 7:00 a.m. shift on 01/30/2023
7:00 p.m. - 7:00 a.m. shift on 01/25/2023
7:00 a.m. - 7:00 p.m. shift on 01/24/2023
7:00 a.m. - 7:00 p.m. shift on 01/23/2023
7;00 a.m. - 7:00 p.m. shift on 01/22/2023
7:00 p.m. - 7:00 a.m. shift on 01/22/2023
7;00 a.m. - 7:00 p.m. shift on 01/21/2023
7:00 p.m. - 7:00 a.m. shift on 01/21/2023

Patient #5
Review of Pt. #5's medical record revealed an admit date of 12/31/2022 and a discharge date of 01/09/2023. Further review reveled a primary diagnosis of Dementia with behavioral disturbances.

Review of Pt. #5's medical record revealed no nursing shift assessments for:
7:00 a.m. - 7:00 p.m. shift on 01/02/2023
7:00 p.m. - 7:00 a.m. shift on 01/02/2023
7:00 a.m. - 7:00 p.m. shift on 01/03/2023
7:00 p.m. - 7:00 a.m. shift on 01/03/2023
7:00 a.m. - 7:00 p.m. shift on 01/05/2023
7:00 p.m. - 7:00 a.m. shift on 01/05/2023
7:00 a.m. - 7:00 p.m. shift on 01/06/2023
7:00 p.m. - 7:00 a.m. shift on 01/06/2023
7:00 p.m. - 7:00 a.m. shift on 01/07/2023
7:00 a.m. - 7:00 p.m. shift on 01/09/2023

Review of Pt. #5's Observation check sheet/Graphic Flowsheet for date of service 01/05/2023 revealed no RN's initials every 2 hours as per the hospital's policy and procedure.

In an interview on 02/22/2023 at 2:03 p.m. S1RN verified the failure of the hospital's Registered Nursing staff to document the care of the patients identified above.

Based on record review and interview, the hospital failed to implement an effective, consistent discharge planning process that included the patient and caregivers at an early stage of hospitalization for post discharge care. This deficient practice was evidenced by the failure to contact the family for participation in the plan of care and discharge planning for 1 (Pt. #5) of 5 (Pt. #1 - Pt. #5) sampled records reviewed.
Findings:

Review of the policy and procedure titled, "Discharge Planning Transition Record" revealed, in part, discharge planning should encompass the following areas: Family's needs post discharge, patient/family's continued education needs. Further review revealed social services personnel shall notify patient and family of the date discharge will occur.

Review of Pt. #5's medical record revealed an admit date of 12/31/2022 and a discharge date of 01/09/2023. Further review revealed Pt. #5 was diagnosed, in part, with Dementia with behavioral disturbances.

Review of Pt. #5's medical record revealed no family contact within 48 hours of admission, during the development of the multidisciplinary treatment plan or prior to discharge.

In interview on 02/23/2023 at 10:34 a.m., S10SW indicated she was assigned to Pt. #5 and based on her review of Pt. #4's medical record she did not include the family member during this hospital encounter. S10SW indicated the family is usually contacted for collateral information within 48 hours of the admit date. S10SW indicated another social worker completed the psychosocial assessment, and there was no contact with the family to obtain collateral information. S10SW indicated the family was not included in the development of the multidisciplinary treatment plan. S10 SW indicated the family was not included in the discharge planning process.

Based on record review and interview, the hospital failed to revise a multidisciplinary treatment plan following a change in a patient's status which resulted in the implementation of seclution. This deficient practice was evidenced by 1 (Pt. #4) of 5 (Pt. #1 - Pt. #5) sampled records when the hospital failed to update the multidisciplinary treatment plan following an incident of seclusion.
Findings:

Review of the policy and procedure titled, "Seclusion and Restraint" revealed, in part 9. Debriefing - when indicated, identify appropriate modifications to the patient's treatment plan.

Review of the policy and procedure titled, "Treatment Planning" revealed, in part, the multi-disciplinary treatment team, under the direction and supervision of the attending physician, shall develop an integrated written, comprehensive Treatment Plan with specific goals and objectives necessary to address deficits and cultivate strengths identified in the assessment. The treatment plan includes defined problems and needs, measurable goals and objectives based on assessed needs and identified by the patient, strengths and limits, frequency of care, treatment and services, facilitating factors and barriers, and transition criteria to lower levels of care.

Review of Pt. #4's medical record revealed an admit date of 01/18/2023 with a primary diagnosis of Schizoaffective Disorder, bipolar type. Further review revealed on 02/02/2023 at approximately 1:45 p.m., Pt. #4 was placed in seclusion.

Review of Pt. #4's multidisciplinary treatment plan revealed no revision to include the patient's change in status, interventions implemented, including the use of seclusion, and revision of the treatment goals.

In an interview on 02/22/2023 at 2:03 p.m., S1RN verified the treatment plan had not been revised following Pt. #4's change in condition resulting in the use of seclusion.