HospitalInspections.org

Based on review of clinical records and interview it was determined the Facility failed to assure chemical restraints were not ordered PRN (as needed) for 11 of 11 Patients on the Behavioral Health Unit. Failure to assure chemical restraints were not ordered PRN did not assure Patients behavior was managed by physician order and not at the discretion or convenience of a nurse. The failed practice was likely to affect all patients admitted to the Behavioral Health Unit. This is a recurrent deficiency that was cited on a complaint survey conducted 10-02-14. This failed practice was likely to affect all patients admitted to the Facility. Example of the findings follow:
A. Patient #18 was admitted 08-17-16 to the Behavioral Health Unit. Review of the Orders written by the Physician for Patient #18 on 08-17-16 revealed Haldol...IntraMuscular, Q (every)4H(hours) PRN (as needed) for Agitation...
B. Patient #19 was admitted 09-12-16 to the Behavioral Health Unit. Review of the Orders written by the Physician for Patient #19 on 09-12-16 revealed Haldol...IntraMuscular Q4H PRN for Agitation.
C. Patient #20 was admitted 09-15-16 to the Behavioral Health Unit. Review of the Orders written by the Physician for Patient #20 on 09-15-16 revealed Haldol...IntraMuscular Q4H PRN for Agitation.
On 09-27-16 at 0130 the Chief Nursing Officer verified the examples listed in A, B and C during an interview.

Based on clinical record review and interview, it was determined the Facility failed to document patients were given/offered a bath daily for six (#1, #4, #6, #8, #10, and #12) of 12 (#1-#12) inpatients. The failed practice did not ensure patients were given the opportunity to bathe and created the likelihood to affect all inpatients in the Facility. Findings follow:

A. Review of clinical records revealed the following:
1) Patient #1 was admitted from 05/19/16 through 05/23/16 (four days). There was no evidence of a bath for three days.
2) Patient #4 was admitted from 02/09/16 through 02/14/16 (five days). There was no evidence of a bath for one day.
3) Patient #6 was admitted from 05/19/16 through 05/27/16 (eight days). There was no evidence of a bath for one day.
4) Patient #8 was admitted from 03/16/16 through 03/24/16 (eight days). There was no evidence of a bath for seven days.
5) Patient #10 was admitted from 02/07/16 through 02/16/16 (nine days). There was no evidence of a bath for six days.
6) Patient #12 was admitted from 11/30/15 through 02/10/16 (72 days). There was no evidence of a bath for 32 days.

B. During an interview on 09/28/16 at 1445, the Chief Nursing Officer confirmed the lack of bath documentation.