HospitalInspections.org

Based on record review and interview, the facility failed to provide treatment plans that indentified patient-related short-term and long-term goals stated in observable, measurable, behavioral terms for 7 of 7 sampled patients (A1, A2, A3, A4, A5, A6, and A7). This failure hinders the ability of the treatment team to measure change in the patient as a result of treatment interventions and has the potential to contribute to failure of the team to modify plans in response to patient needs.

Findings Include:

RECORD REVIEW:

1. Patient A1's treatment plan dated 1/27/14 listed for the problems "Potential Danger to Self:, Potential Danger to Others: Acute/Emergent Condition." "Oppositional Defiant Disorder:" noted the following goal: "safety of self and others"

2. Patient A2's treatment plan dated 1/22/14 listed for the problems "Potential Danger to Self," "Potential Danger to Others," "Acute/Emergent Condition," "Oppositional .Defiant." "Abuse/Neglect/Attachment Issues," noted the following goals "safety of self and others-pt [patient] will learn coping skills and be able to use them rather than self harm or harm others."

3. Patient A3's treatment plan dated 1/22/14 listed for the problems "Potential Danger to Self", "Acute/Emergent Condition," "struggling with sexual identity," noted the following goals "safety of self-pt [patient] will able (sic)to use coping skills and not self harm."

4. Patient A4's treatment plan dated 1/24/14 listed for the problems "Potential Danger to Self," "Potential Danger to Property," "Agitated/Anxiety Reaction," "Acute/Emergent Condition," "Oppositional Defiant", " Potential Danger to Others," "Abuse/Neglect/Attachment Issues " noted the following goals: "decrease anger, defuse escalating episodes."

5. Patient A5's treatment plan dated 1/21/14 listed for the problems "Potential Danger to Others", "Agitated/Anxiety Reaction," "Social Skills Deficit," "Acute/emergent Condition," "Oppositional/Defiant." "Abuse/Neglect Attachment Issues", noted the following goals "Decline in aggressive behavior, coping skills which are age appropriated (sic)."

6. Patient A6's treatment plan dated 1/24/14 listed for the problems "Potential Danger to Self," "Agitated/Anxiety Reaction," "Acute/Emergent Condition," "Psychotic or Confused Thought Process" noted the following goal "Discuss psychotic symptoms, fewer intrusive thoughts."

7. Patient A7's treatment plan dated 1/16/14 listed for the problems "Potential Danger to Self," "Depressive Symptoms," noted the following goal "No further self-harm or thoughts of suicide."

INTERVIEWS

1. In an interview on 1/28/14 at 10:30 AM the Director of Quality Assurance concurred that the goals listed on treatment plans were not observable, measurable, or behavioral.

2. In an interview on 1/28/14 at 11:00 AM the APRN1 concurred that the goals listed on treatment plans were not observable, measurable, or behavioral.

3. In an interview on 1/28/14 at 2:00 PM the Medical Director and the DON agreed that the goals on the treatment plans were not observable, measurable, or behavioral.

Based on record review and interview, the hospital failed to identify by name and discipline the treatment team member responsible for the modalities selected for 7 of 8 active patients (A1, A2, A3, A4, A5, A6, and A7) The treatment plans listed only the treatment modalities and did not identify the specific names and disciplines of those staff members responsible for those treatment modalities. This has the potential to create an inability to determine what staff member is responsible for ensuring compliance with the various aspects of treatment.

RECORD REVIEW:

1. Patient A1's treatment plan dated 1/27/14 did not identify the staff responsible for the treatment modalities selected.
2. Patient A2's treatment plan dated 1/22/14 did not identify the staff responsible for the treatment modalities selected.
3. Patient A3's treatment plan dated 1/22/14 did not identify the staff responsible for the treatment modalities selected.
4. Patient A4's treatment plan dated 1/24/14 did not identify the staff responsible for the treatment modalities selected.
5. Patient A5's treatment plan dated 1/21/14 did not identify the staff responsible for the treatment modalities selected.
6. Patient A6's treatment plan dated 1/24/14 did not identify the staff responsible for the treatment modalities selected.
7. PatientA7's treatment plan dated 1/16/14 did not identify the staff responsible for the treatment modalities selected.


INTERVIEWS

1. In an interview on 1/28/14 at 10:30 AM the Director of Quality Assurance concurred that the treatment plans did not indicate the specific staff responsible for implementing the modalities selected

2. In an interview on 1/28/14 at 11:00 AM the APRN1 concurred that the treatment plans did not indicate the specific staff responsible for implementing the modalities selected.

Based on record review and staff interview it was determined that the facility failed to provide professional therapeutic staff that would design and implement structured therapeutic activities. This failure resulted in a lack of structured therapeutic groups/activities to assist the patient in meeting their treatment goals.

Record review:

A review of medical records revealed an absence of structured individualized therapeutic activities for patients (A1, A2, A3, A4, A5, A7 and A8). Instead activities were determined on as needed basis depending on the population on the unit and were provided by nursing staff/mental health workers without consultation from a professional therapeutic activities staff member.

Interviews:

An interview was conducted with a mental health worker on 1/28/29 who stated "that activities were provided based on the needs of patients who were on the unit." He stated that "he would probably do a self- esteem group today as it was an issue with the patients who were currently on the unit". He further stated that other activities included painting, drawing, journaling, games, and puzzles were also were offered to patients.

An interview was conducted with the Nurse Executive on 1/28/14 who stated that there are no longer any professional therapeutic staffs available to consult with the nursing staff/mental health workers who provide activities for the patients.