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Based on record reviews and interviews, the hospital failed to ensure that each patient's individualized comprehensive treatment plan included interventions relative to the treatment of hypothyroidism/hyperthyroidism for 2 (#F1, #F2) of 10 (#F1 - #F10) active patients' records reviewed for treatment plan development from a total sample of 10 patients.
Findings:

Review of the hospital policy titled "Inter-Disciplinary Treatment Planning Overview," policy number NU.706, revised 06/20/12, and presented as the current policy by SF2DON (Director of Nursing), revealed that each patient admitted shall have a comprehensive, individualized treatment plan which is based on interdisciplinary clinical assessments. Further review revealed the treatment planning process is continuous, beginning at the time of admission and continuing through discharge. Based on intake information and the nursing assessment, the initial treatment plan is developed and addresses the most immediate and obvious needs of the patient. In order to determine the effectiveness of the master treatment plan, weekly reviews are done by the interdisciplinary team. This review will provide valuable information about patient progress, need for continued treatment, and revision of interventions as well as discharge planning.

Patient #F1
Review of Patient #F1's medical record revealed he was an 80 year old male admitted on 05/29/14 with diagnoses of Dementia, Hypertension, Hypothyroidism, Cardiac Disease, and Hyperlipidemia. Review of his "Psychiatric Evaluation" performed on 05/29/14 by SF12APRN (Advanced Practice Registered Nurse) revealed Patient #F1's Axis III diagnoses included Hypertension, Vertigo, Hyperlipidemia, Hypothyroidism, although at this point in time it does appear that it may be medically induced hyperthyroid, history of Back Pain, Osteoarthrosis, and history of Asthma.

Review of Patient #F1's multidisciplinary treatment plan revealed a plan was initiated for Psychosis With Behavioral Disturbance, Risk For Injury/Falls, Violence, Decreased Cardiac Output, and Alcohol Withdrawal. Further review revealed a plan was initiated on 06/08/14 for Infection related to Conjunctivitis.

Review of Patient #F1's "Physician's Orders" revealed an order on 05/29/14 at 1:15 p.m. to hold Levothyroxine until seen by SF13Physician. Further review revealed an order on 05/29/14 at 6:00 p.m. by SF13Physician to hold Levothyroxine for 7 days and then resume at 50 mcg (micrograms), 1 by mouth every day.

Review of Patient #F1's "Weekly Treatment Team Review" for 05/30/14 and 06/06/14 revealed no documented evidence that holding Patient #F1's Levothyroxine and the subsequent change in his dose of Levothyroxine when it was restarted had been addressed. Further review revealed no documented evidence that his treatment plan was revised to address his medically induced Hyperthyroidism.

In an interview on 06/11/14 at 11:50 a.m., SF2DON confirmed that Patient #F1's treatment plan should have been revised to include his medically induced Hyperthyroidism.

Patient #F2
Review of Patient #F2's medical record revealed he was a 60-year-old male admitted on 05/28/14 with diagnoses of Psychosis with Behavioral Disturbance, Non-compliance with Medications, Hypertension, Diabetes Mellitus (Type II), Hypothyroidism, and Cellulitis of Left Leg.
Review of Patient #F2's Psychiatric Evaluation completed on 05/29/14 revealed a diagnosis under Axis III of Hypothyroidism. Review of the Master Treatment Plan Cover Sheet revealed a diagnosis of hypothyroidism in the space allotted for Axis III diagnoses. Review of Patient #F2's Medication Administration Record (MAR) revealed medication for hypothyroidism, Levothyroxine 88 mcg (micrograms) had been ordered by the physician to be given once a day at 6:00 a.m. Review of the MAR revealed that Patient #F2 had been receiving this medication.
Review of Patient #F2's Comprehensive Treatment Plan revealed Patient #F2 did not have a treatment plan developed for the diagnosis of hypothyroidism.
In an interview on 06/11/14 at 2:40 p.m., SF2DON indicated the only intervention she had done to address the deficiencies related to Treatment Plans was to inservice the staff. She further indicated the Treatment Plan forms were still under revision and had not been implemented yet.