HospitalInspections.org

Based on interview and record review the facility failed to ensure that they followed their own policies and procedures regarding patient's representative being able to fully exercise their rights for 1 of 20 patients sampled (#19). The failure to allow a patient's representative to exercise their rights has the potential to cause the patient to be subject to unwanted testing.

Findings:

Review of the medical record for patient #19 reveals that the patient was admitted to the facility under a baker act on 4/13/2010 and was subsequently confined to the facility by court order. The record also indicates that the patient's adult child was appointed as guardian advocate.

Interview with patient #19's physician on 6/8/2010 reveals that the guardian advocate was extremely resistant to the use of psychotropic medications and that this limited the treatment plan. She further stated that she wanted to obtain some laboratory (lab) testing to rule out a previously undiagnosed medical condition. According to the physician, she was considering discharging the patient after the labs were obtained because she felt she could not provide active treatment without the ability to use psychotropic medications.

During interview on 8/8/2010 at 11:30 AM with Licensed Practical Nurse (LPN) #2 he stated that the patient was agitated all day, on the day that he/she was discharged from the facility. Further interview with the LPN revealed that the morning the patient was discharged, the patient had moved during a blood draw and that the phlebotomist had been stuck with a contaminated needle.

Review of the physician's orders revealed an order dated 4/22/2010 for a complete blood count (CBC) and a comprehensive metabolic panel (CMP). Further review of the physician's orders also revealed an order dated 4/23/2010 at 12:40 AM that reads, "send out to [Emergency Room] for STAT labs: due to phlebotomist being secondarily stuck by needle need results stat Hepatitis B+C, CMP, CBC with [differential], HIV, VDRL STS CMP, CBC with Diff " signed by patient #19's physician.

Review of the progress note dated 4/23/2010 and timed at 10:15 PM, as a late entry, reveals that the guardian advocate was told that the patient had discharge orders and would be discharged after returning from having blood drawn. The progress note also indicates that the guardian advocate asked if the discharge was contingent on blood being drawn and wanted to obtain a written notice that is was required for discharge. The progress note further indicates that the guardian was told that the physician would have to be contacted and that the guardian agreed to have the blood drawn only to be able to leave with patient #19.

A review of the facility provided policy entitled parenteral/mucous membrane exposure to blood or OPIM reveals that it includes the following statement, "the source patient is to be notified by his/her attending physician, of the incident and the protocol for patient consent for HIV testing is to be followed."

During interview with the Risk Manager on 6/7/2010 at 2:00 PM she stated, "I don't know," when asked why the guardians whishes had not been respected.