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Based on interview and record review, the facility failed to document, analyze, and identify possible preventative measures following an incident that involved a patient leaving AMA (against medical advice) and being escorted out of the building.
[citing Patient # 4]

Findings included:

TX 00326173

Review of facility policy titled "Risk Management-Notification of Occurrences,"dated 03/2016, showed the policy"...provided a mechanism for reporting unusual occurrences and operational variances not consistent with normal hospital operations and patient treatment expectations..." The policy showed that:

*The online reporting system should be used to document patient complaints affecting quality.

* Employees are responsible to document & report occurrences.

* Each incident should be reported to the immediate supervisor as soon as possible, but no later than the end of the shift.

* Department manager/supervisor completes their portion of the report with the goal of 5 days of the event; no later than 15 days from the event.

* Risk Manager reviews & analysis the report and reports trends to the Patient Safety Committee.

* When applicable the risk manger will facilitate an Apparent Cause Analysis or a Serious Event Analysis whichever is appropriate.

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Review of intake # TX 00326173 detailed an account that involved Patient #4; a visitor; and various facility staff members, including administrative representative. The intake narrative described allegations related to pain management & allegations the facility mishandled a situation resulting in security escorting the patient & family out of the building. Patient # 4 was hospitalized September 2019 with pneumonia.

Record review of Patient # 4's clinical record showed she was a 39 year old female admitted to the facility on 9/28/19 with fever and cough; bilateral pneumonia.

Record review of nursing documentation dated 09/29/19 at 2140 showed lengthy description of interactions among Patient #4, a visitor, nursing staff, and "administrator on site (AOS)." Nursing documentation described an escalating situation:facility staff attempted to discuss Patient # 4's concerns about pain management. It was documented in the record that Patient # 4's visitor became hostile; he was informed security was going to be called to escort him off the property. Documentation showed Patient # 4 was not satisfied with how the situation was handled. Patient # 4 removed her pulse oximeter and the IV (intravenous) line from her arm and began yelling. Patient # 4 requested to leave and refused to sign the against medical advice (AMA) form. Security was called and Patient # 4 was escorted from the building

Record review of facility occurrence / incident log for 2019 failed to reveal a any documentation related to the incident involving Patient # 4.

Interview on 11-21-19 at 2:40 PM with Staff I, nurse manager, she stated the incident should have been documented in the online system as a variance.

Interview on 11-21-19 at 12:40 PM with Staff E, Patient Safety Director, she stated this incident should have been entered as an occurrence so that it could have been analyzed for possible improvement opportunities.

Based on interview and record review, the facility failed to monitor a patient appropriately after administering intravenous medication in the emergency room (ER). [citing Patient # 5 ]

Findings included:

TX 00320441

Review of facility policy titled "Medication Administration-Adult & Pediatric,"dated 01/2017, showed staff were expected to use their professional judgement to assure medications were delivered in a safe manner. Staff was to take into account the nature and variability of the medication and the needs of the patients receiving the medication.

Review of complaint intake TX 00320441 showed an allegation that Patient # 5 was "discharged (from ER) prior to knowing if there would be a drug interaction."

Review of the ER record of Patient # 5 showed she was a 57 year old female who presented to the ER on 04/17/19 at 22:03 with complaint of headache following an epidural injection earlier that day.

Review of Patient # 5's ER medication Administration Record (MAR), dated 4/18/19 showed the following:

a. Toradol 30 milligrams (mg) was administered IV at 1:48 AM;

b. Haldol 4 mg was administered IV at 1:50 AM.

Review of the "Discharge Instructions" for Patient # 5 showed that she signed the instructions and was discharged from the ER at 1:56 AM.

Interview on 11-21-19 at 2:30 PM with Staff K, ER nursing director, she stated that typically a patient should be observed for 15 to 30 minutes after an IV medication was administered. She went on to say if Haldol was administered IV, the patient should be kept for 30 minutes to observe for unexpected effects.

The ER nursing director said discharging a patient 6 minutes after administering IV Haldol was not acceptable.