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Based on interview and record review, the facility failed to provide written notice of its decision in the resolution of a grievance for 1of 1(#14 ) grievances reviewed. Findings include:

On 5/13/10 at 1130, patient #14's clinical record was reviewed with the Director of Patient & Guest Services and Patient Relations Manager. The facility documented "concerns" reviewed with the patient's mother on 3/30/10. The facility classified these grievances as complaints, many of which were not resolved. The facility failed to respond to the complainant in writing.

Based on interview, policy review and record review, 1 of 1 patient representatives (for patient #14) was not allowed to represent him on a full-time basis. Findings include:
Patient #14 was admitted with multiple wounds, involving artery, liver, kidney, lung and back lacerations. Ventilator support was required. Throughout his hospitalization, patient #14 ' s mother was asked to sign all hospital consent forms on his behalf. Patient #14 ' s mother and an adult sister were his most frequent visitors. On day 31 of the patient ' s stay, his mother was asked to meet with administrative staff and told, " ...she (patient #14 ' s mother) is only allowed to visit her son from 2pm-3pm daily ...A privacy hold has been placed and she is not permitted to call and receive information over the phone. She may bring other visitors with her when she comes daily at 2 pm, but there will not be any visitors at other time. " (Facility memo titled " NCU 7, " dated 4/8/10.)
All documentation regarding incidents or behavioral concerns involving patient #14 ' s family was requested. On 5/12/10, from 1200-1600, review of patient #14 ' s medical record revealed a few nursing notes regarding staff concerns with patient #14 ' s mother ' s behavior. No documentation was provided to explain why a " privacy hold " was necessary.
In response to a request for the privacy hold policy, policy #SHS EOC 0302 (describing a "security information hold ") was provided. It states: " The Security Information Hold will be placed on patient admissions that are the result of an aggravated assault, attempted homicide, or wherein the patient ' s admission poses a potential danger to the patient or Associates for other reasons. "
There was no documentation to explain why the patient ' s mother constituted a danger or explained the necessity of denying phone contact privileges. There was documentation of patient #14 ' s mother disagreeing with nursing interventions, complaining about the patient ' s care and becoming agitated when there was a decline in the patient ' s condition. At no time during the patient ' s stay did the facility stop asking the mother to sign consents for treatments and procedures.
There was no evidence of a physician ' s order limiting family visits and phone calls. There was no documentation to explain why patient #14 ' s sister was limited to a 1-hour visit daily.
Per facility policy EWS PCN 0081, last revised 10/07, SectionE4, " You have the right to accept and refuse to see visitors, except in the case of a physician ' s order. " Section G2 states, "You have the right to have your chosen representative communicate your wishes for medical treatment in the event that you are medically incapable of making your own decisions. " These findings were reviewed with the Director of Critical Care.

Based on interview and record review, the facility failed to ensure that 1 of 1 patient's (#14) received oxygen administration per policy and medical staff directives. Findings include:
On 5/12/10 from noon-1600, review of patient #14 ' s clinical record revealed documentation of 1 incident of a drop in oxygen saturation " below 60%, " per RN #2 (Event Report dated 3/27/10). In RN#2 'S Event Report (3/27/10) and phone interview (5/12/10 at 1530), she confirmed that patient #14 ' s oxygen ran out during transport on 3/27/10 with RT #1, and documented observation of an oxygen saturation below 60%.
Respiratory Therapist (RT) #1 accompanied patient #14 on 3/27/10 but did not document a lowest specific oxygen saturation observation when the tank ran out. RT #1 documented: "Pt. vital signs including heart rate were not changed or adversely affected by suspected decrease in oxygen saturation. Cause of suspected oxygen desaturation unknown."
These findings were confirmed with the Director of Critical Care and Neuro-Intensive Care Unit Nurse Manager.