HospitalInspections.org

Based on review of 11 medical records, staff interviews and observations it was determined that the hospital failed to:

Inform all patients, and/or the patient representatives, of patient's rights prior to providing care.

During the admission process patients are requested to sign a "Consent for Medical Treatment" form. This form states, in part, that patients "have received information about patient rights and responsibilities." Observational tours of the Emergency Department, Medical Surgical unit and the Intensive Care unit were completed on 11/16/2015. While completing the unit tours a document posted in the public area was observed. The document stated, "Information about patient rights and responsibilities is available upon request. Please speak to your nurse. If you need additional assistance or have a concern or complaint, please speak with your nurse or you may contact our patient representative at ext. 3487."

Interviews with staff on 11/16/2015 confirmed that patients and/or patient representatives receive notice of patient rights information only if requested.

Failure of staff to ensure that all patients are provided patient's rights before or stopping care does not allow patients the information necessary to exercise their rights.

Based on review of 11 medical records and hospital policies it was determined that staff failed to document that an interpreter service was utilized to provide communication with a non-English speaking patient about treatment and care.

Patient #4's preferred language was Spanish, and he had limited English proficiency. A review of his medical record revealed that staff did not document the use of interpreter services when communicating with the patient. Hospital policy instructs staff to use the language phone line to ensure patient safety and communication between the patient and staff. When the interpreter services are utilized staff must document in the patient's medical record the use of the language line service. Documentation must include the participants in the communication as well as the interpreter's identification number.

Failure of staff to use the interpreter service for limited English speaking patients and to document the use of the language line places the hospital at risk for not allowing patients to exercises their patient rights. The failure also limits the patient's ability to receive information to formulate an informed decision about care and treatment options.

Based on review of 11 medical records and hospital policies and interviews with emergency department staff it was determined that the Emergency Department (ED) staff failed to obtain advanced directives from patients and failed to implement advanced directives for all patients.

Patient #1 present to the ED on the morning of 11/16/2015 by ambulance with a Maryland Medical Order for Life Sustaining Treatment (MOLST) form. The patient had been assessed by the physician and the nurse hours before the record review was completed. The record review revealed that the patient still had not had orders placed for Advanced Directives. Interviews with the ED staff revealed that staff "assume everyone is a full code until the physician writes an order indicating otherwise." Patient #1 had specific advanced directive wishes listed on her MOLST form that had not been documented or addressed by the clinical staff.

An interview with the emergency registrar and the ED nurse manager on 11/16/15 revealed that registration staff does ask patients if the patient has an advanced directive then documents the information in the registration system. However, clinical staff cannot visualize the advance directive information obtained at registration because registrars and clinical staff document in different electronic systems.

According to hospital policy, "MOLST Orders" (policy #PCS22 effective 1/2015), the hospital's licensed practitioner is to review the MOLST form with the patient (or patient decision maker) and then document that conversation in the medical record.

Failure of all hospital staff to implement and comply with patient's advanced directives places the hospital at risk for violating patient's rights.