HospitalInspections.org

Based on observations, staff interviews and document review, the facility failed to maintain the confidentiality of patient information when last names were observed on the exterior of patient charts at the nurses stations of two telemetry (a unit with cardiac monitoring) units.

This failure led to the potential disclosure of protected health information (PHI) and a violation of patient rights.

Findings:

During an observation of 2 South, a Telemetry Unit, on 2/26/19 at 2 p.m., a rotating rack of patient charts was observed at the nurses station. A patient's room number, first initial and full last name were observed on the outside of every chart.

An observation of the nurses station on 2 North, a telemetry unit, was made on 2/27/19 at 9:50 a.m. Behind the desk, a rotating rack of patient charts was observed. On the outside of every chart, a patient room number, first initial and full last name was observed.

In a concurrent interview with the Infection Control Preventionist (ICP) and the Assistant Nurse Manger-Telemetry (ANM), they both acknowledged the names on the charts were within view of the public and presented a privacy concern. When asked if the other units wrote the same patient information on the outside of their charts, the ANM stated, "It is our practice."

According to a 6/1/15 facility policy titled, "Patient Rights and Responsibilities", "the hospital shall comply with the California Code of Regulations, Title 22 requirements for patient rights...all Joint Commission standards and all Federal Conditions of Participation relating to patient rights...The patient has the right, within the law, to personal and informational privacy, as manifested by the right to...expect all communications and other records pertaining to his/her care...to be treated as confidential..."

Based on interview and record review, the hospital failed to follow physician's orders for restraint use when Patient 1 remained in physical restraints for behavioral reasons with an expired restraint order. This failure had the potential to contribute to injury or harm related to restraint use and had potential to preclude or delay physician involvement in decision making related to restraint use.

Findings:

According to an initial physician's note dated 11/15/18 at 3:39 a.m., Patient 1 arrived to the hospital on 11/14/18 by ambulance for breaking a glass door with his head. Patient 1 had a history of Autism Spectrum Disorder (a developmental disorder characterized by difficulty with social interaction, communication, and repetitive patterns of behavior), Attention Deficit Hyperactivity Disorder (a developmental disorder with symptoms of inattention and the inability to stay still or control behavior), behavioral problems, language disorder, agitation, and intermittent explosive disorder (a behavioral disorder with characterized by outbursts of anger and violence). The note described Patient 1's history as, "...tendencies to have head trauma from head banging. He has a healing scalp wound without new trauma..."

During a 2/28/19, 2:10 p.m. concurrent interview and electronic medical record review with the Director of Emergency Department (DED) the following was reviewed:

a. A 11/22/18 at 12:20 a.m. physician order, "Request for Restraints for Behavioral Reasons" due to, "Imminent risk of harm to self or others", with a duration time of two hours.

The next restraint order, of the same type, was placed at 11/22/18 at 4:55 a.m., over four hours later.

b. A 11/24/18 at 2:17 a.m. physician order, "Request for Restraints for Behavioral Reasons" due to, "Imminent risk of harm to self or others", with a duration time of two hours and a note, "Starting at 0300 (3:00 a.m.).

The next restraint order, of the same type, was placed at 11/24/18 at 6:25 a.m., approximately 3 hours later.

c. A 11/24/18 at 8:47 p.m. physician order, "Request for Restraints for Behavioral Reasons" due to, "Imminent risk of harm to self or others", with a duration time of two hours.

The next restraint order, of the same type, was placed at 11/25/18 at 1:21 a.m., over 4 hours later.

In a 2/28/19, 2:10 p.m. concurrent interview and record review of required monitoring flowsheets and corresponding nursing notes, the DED acknowledged Patient 1 remained in restraints past the order's 2 hour expiration times as listed above.

A review of the hospital's policy titled, Restraints NCAL Regional Policy, revised 10/10/17, identified, "... 5.6 Restraint shall be initiated or continued upon the order of a physician... 5.11 Restraint may only be employed while the unsafe situation continues and must be discontinued at the earliest possible time..." The policy further directs, "5.18.7.2 Violent, Self- Destructive Behavior Restraint Order... The order must be time- specific, with a maximum duration of... 2 hours for a child or adolescent 9-17 years of age...When the original order is about to expire, the registered nurse must contact the treating physician, report the results of his/her most recent assessment, and request that the original order be renewed for another period of time not to exceed the age specific time limit."