HospitalInspections.org

Based on review of hospital policy/procedure, Daily Patient Assignment Sheets, personnel files and interviews, it was determined that the hospital failed to require that the assignment of nursing care for each patient in the Geropsychiatric Unit was in accordance with the patients' needs and the qualifications and competence of available nursing staff for 16 of 16 patients assigned to Psychiatric Technicians on the day shift, 2/28/14.

Findings Include:

Review of hospital policy/procedure titled: Inpatient Staffing/Acuity Plan and Patient Acuity Tool Guidelines revealed: "...The number and mix of nursing personnel needed for each unit and shift is determined by the care needs of the patients, the complexity of the patients, any special needs of individual patients, competence of nursing personnel, qualifications of nursing personnel, education of nursing personnel and the experience of the nursing personnel...An acuity rating for each patient is performed each shift...to project and facilitate the care needs and care requirements of the patients...based on the treatment plan, observations, activities, interventions and assessment information related to each patient...The charge RN will make staffing assignments as appropriate to patient needs and taking into consideration the specialized qualifications and competency of the nursing staff available. When making assignments the charge RN will consider: a. Patient needs...b. Complexity of the patients...c. Patient special needs...d. Competence of nursing personnel...e. Qualifications of nursing personnel...f. Education of nursing personnel...g. Experience of nursing personnel...Patient care assignments will be made taking into consideration the acuity and nursing care needs of the patients and will not be made based on geographic room locations of patients on any unit...."

Review of the Daily Patient Assignment Sheet for the Generations Unit (Geropsychiatric Unit) revealed 3 Psychiatric Technicians (PT) assigned to individual patients. PT # 3 was assigned to 5 patients, located in rooms 349 through 356. PT # 4 was assigned to 5 patients, located in rooms 357 through 362. PT # 5 was assigned to 6 patients, located in rooms 363 through 368. The assignment sheet contained acuity ratings for the patients assigned to the RNs, but it did not contain acuity ratings for the patients assigned to the PT's.

The Charge RN confirmed, during interview conducted on 2/28/14, that s/he assigned patients to the PT's based on geographic room locations of the patients.

Review of the hospital patient census for 2/28/14, revealed that patients admitted to the Generations Unit all had psychiatric admitting diagnoses, including but not limited to, Dementia, Mood Disorder, Psychotic Disorder, Bipolar Disorder and Depressive Disorder.

Review of the personnel files of PT's # 3, 4 and 5 revealed that they did not contain documentation of competence, prior experience, or skills training related to the care and/or supervision of patients with psychiatric disorders.

The Director of the Generations Unit confirmed, during interview conducted on 2/28/14, that PT's # 3, 4 and 5, who were assigned to provide care to patients residing in the Geropsychiatric Unit, did not have documented competence, prior experience or training related to the care of patients with psychiatric disorders.