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Based on observation, policy review, medical record review, and surveillance video, the hospital does not meet the emergency needs of patients. Specifically, nursing staff did not follow physician orders and the facility policy for direct visualization monitoring of Patient #1. Subsequently, Patient #1 eloped from the emergency department (ED).
Findings include:

See Tag A-1104

Based on observation, policy review, medical record review, and surveillance video, nursing staff did not follow physician orders and the facility policy for direct visualization monitoring of Patient #1. Subsequently, Patient #1 eloped from the emergency department (ED).

Findings Include:

Observation on 3/15/23 at 11:00 AM of the Hospital ED revealed room 7, where Patient #1 was housed on 9/21/22 and 9/22/22, is approximately 15-20 feet in direct view of nurse ' s station.

Review of policy "Identification, Assessment, and Planning Care for Individuals at Risk for Suicide Policy" last reviewed 02/2022 indicates the definitions of patients at risk are: diagnosed with a primary or secondary emotional or behavioral illness; admitted after a suicide attempt; admitted with injury that appears to be self-inflicted or of unexplained origin; patients expressing or demonstrating symptoms of severe depression or mania; and identified as "at risk" through completion of a suicide screen. Direct visualization for suicide or at risk means a situation in which a staff member is responsible for maintaining visual observation of patient(s), either by line of sight or via video monitor.

Review of ED medical record for Patient #1 revealed the following:
-On 9/21/22 at 9:58 PM, the ED physician completed a medical screen exam and placed orders for direct visualization (monitoring) and an ED Comprehensive Psychiatric Emergency Program (CPEP) consult. Patient #1 was uncooperative with disorganized thoughts and flight of ideas, but without suicidal ideation.
-On 9/22/22 at 7:00 AM, ED Physician documents that Patient #1's history is limited, not giving much information. Patient #1 appears paranoid and was a policy mental health transport (9.41 transport-Emergency admissions for immediate observation, care, and treatment).
-On 09/22/22 at 1:00 AM, the mental health progress note by the licensed mental health counselor revealed Patient #1 was alert and oriented, with intact memory (unclear if what patient is telling is true or a delusion at this time). Cooperative to an extent, will only give limited information. Patient #1's appearance is neat, appears stated age, good eye contact, and guarded in behavior with thought content. Unable to confirm any parts of Patient #1' s story, thinks part of the royal family. No suicidal ideation or harm to others. Patient #1's insight is impaired or possibly impaired due to potential psychosis. Judgement is impaired. Social/psychiatric history is unknown. The plan for Patient #1 after conferring with the Psychiatrist, is to have Patient #1 remain in the ED while attempting to obtain collateral and hopefully a urine tox. Once collateral was obtained, psychiatric disposition would be determined.
-Nursing documentation recorded staff attempts to provide care, Patient #1 refused of care, and that Patient #1 was visible on 9/21/22 at 9:50 PM, 9:59 PM, 10:19 PM, and 10:20 PM. On 9/22/23 at 2:01 AM, 5:23 AM, 6:00 AM, 7:00 AM, 7:39 AM, and 7:52 AM. No nursing documentation was found between 7:52 AM and 9:00 AM.
-On 9/22/22 at 7:52 AM, nursing note revealed that mental health exam is complete, awaiting collateral (information). The CPEP team is unable to reach anyone at numbers provided by Patient #1 and are going to reach out to the Department of Social Services (DSS) this morning for more information.
-On 9/22/22 at 9:00 AM, nursing note revealed that while the nurse was on the phone, Patient #1 exited room and ran towards the door. Security was called immediately. The RN and another staff member attempted to locate Patient#1 down the hallway, unable to visualize Patient #1. Security attempting to locate Patient #1. The Nurse Manager and Supervisor are aware. The physician was notified and aware.
-On 9/22/22 at 10:00 AM, nursing note revealed per security staff, Patient #1 eloped through the south entrance and remains at large. Prior to that, Patient #1 was observed on video near the laboratory. Laboratory jackets were missing from the laboratory. Patient #'s clothing and wristbands were found in lab bathroom.

Review of video footage of the facility dated 9/22/22 at 9:31 AM shows a person wearing a laboratory coat (identified as Patient#1), exiting the building, and walking into the parking lot. At 9:37 AM, the person entered a car and drove off.