HospitalInspections.org

Based on review of facility documents, medical records (MR), and staff interviews (EMP), it was determined the facility failed to provide a 1:1 sitter for two of seven suicidal patients reviewed and failed to provide adequate nursing staff to ensure medications and treatment were provided as ordered for seven of 15 medical records (MR1, MR2, MR3, MR4, MR5, MR6, and MR7).

1) Review on January 4, 2019, of the facility's policy, "Assessment And Intervention Of The Suicide Risk Patient," last revised October 21, 2018, revealed "Purpose Lehigh Valley Hospital-Pocono (LVH-P) clinical staff will proactively screen patients for the risk of suicide. Patients identified to be a risk for suicide and/or being treated for emotional or behavioral disorders will be further assessed using the Columbia-Suicide Severity Rating (C-SSR) Scale. General Guidelines If a concern arises that the patient's C-SSR does not match a patient's behavior, then clinical judgement will prevail, and the patient will be placed on Suicide Precautions which will include 1:1 observation until a physician can be notified for further orders Any hospital staff that identifies patient as being at risk for suicide will notify the charge or primary nurse immediately. Suicide Precaution Procedure Form/Flowsheet (MH-11 0F/B; MRC-465) will be utilized for all patients placed on suicide precautions. 1:1's will be assigned by ED charge RN, Clinical Supervisor, Administrative Nurse Manager. Attending physician orders suicide precautions and consults psychiatry. ..."

Review on January 4, 2019, of MR1 revealed MR1 was a 17-year-old female and arrived at the ED with police escort and complaint of self-harm on December 31, 2018 at 03:19. MR1 presented with lacerations to her thigh and neck with controlled bleeding. MR1 was seen and assessed by a physician. There was documentation in MR1 for a physician ordered 1:1 observation at 04:18.

Continued review of MR1 revealed a nurse's note on December 31, 2018 at 04:19 which stated, currently no staff for 1:1, Charge Nurse, Supervisor made aware. MR1 was transferred to a psychiatric treatment facility on December 31, 2018 at 21:37. There was no documentation MR1 was provided 1:1 observation while treated in the ED at the facility.

Interview on January 4, 2019, at approximately 12:00 PM, with EMP3 revealed she had no knowledge MR1 was not provided a 1:1 in the ED. EMP3 confirmed there was no documentation MR1 was provided a 1:1 while in the ED. EMP3 spoke with the nursing supervisor EMP4 from December 31, 2018. EMP4 stated she could not recall events from December 31, 2018.

Review on January 4, 2019, of MR2 revealed MR2 was a 25-year-old male and arrived at the ED on December 24, 2018, at 11:18 with complaints of suicidal thoughts. There was documentation MR2 was seen and assessed by a physician. There was documentation in MR2 for a physician ordered 1:1 observation at 11:48.

Continued review of MR2 revealed MR2 was not provided a 1:1 until 12:30 on December 24, 2018. There was no documentation MR2 was provided a 1:1 from 11:48 to 12:30.

Interview on January 4, 2019, at approximately 2:00 PM, with EMP2 confirmed MR2 was not provided a 1:1 from 11:48 to 12:30 on December 24, 2018. EMP2 confirmed MR2 was ordered a 1:1 on December 24, 2018 at 11:48.

2) Review on January 16, 2019, of the facility's policy, "Staffing Scheduling Procedures," no date of last review, revealed "Purpose It is the policy of the following Patient Services Departments of Pocono Medical Center to establish and maintain adequate staffing levels on all patient care units utilizing the scheduling process of full-time, float, part-time, weekend option, agency alternative and per diem. ... c. Staffing Office Scheduling Process ... vi. Adjust schedule according to census 1. Six times a day, units will have new staffing requirements calculated for them automatically based on the latest census. The staffing office and/or Administrative Supervisor adjusts the schedule to meet the new needs by allocating resources as needed or adjusts staffing as needed (see guidelines below). 2. Review daily staffing worksheet regularly throughout the shift noting changing needs due to call-ins, census, and acuity of units. 3. Utilize all resources. If additional help is needed on short notice, beginning with per diems, agency alternatives and regular staff for additional shifts. ..."

Review on January 16, 2019, of the facility's policy, "Patient's Rights And Responsibilities," no date of last review, revealed "... 6. The right to privacy and to receive care in a safe environment. ... 8. The right to good quality care and high professional standards that are continually maintained and reviewed. ... 12. The right to expect good management techniques to be implemented within Pocono Health System with regards to effective use of time of the patient, and to avoid causing the [sic] any personal discomfort. ... 14. The right to expect emergency procedures to be implemented without unnecessary delay. ..."

Review on January 16, 2019, of MR3 revealed MR3 had a change in condition as an inpatient on the Telemetry Unit on December 31, 2018. There was documentation MR3 experienced deteriorating oxygen saturation levels and required a higher level of care. There was a physician order for MR3 to be transferred to the ICU on December 31, 2018 at 1634. There was also documentation there was no bed available in the ICU due to staffing. MR3 was not transferred to the ICU until 1950 on December 31, 2018.

Interview on January 16, 2019, at approximately 1:00 PM, with EMP2 confirmed there was documentation there was a physician order to transfer the patient to the ICU at 1634. EMP2 confirmed the transfer took over three hours to be completed and there was documentation no ICU bed was available due to staffing.

3) Review on January 16, 2018, of the facility's policy, "Medication Administration Times," no date of last review, revealed "Purpose To outline the process for administration of scheduled medication orders throughout the Hospital using standard administration times. Pharmacy and Nursing will adhere to P&T approved list of standard medication administration times for all scheduled medication order entry and documentation systems. The list will be posted in Pharmacy and all patient care areas. ... b. Procedure ... ii. All medication must be administered at the time due. There is a plus/minus sixty (60) minute window for medication administration. iii. Documentation should be made with any administration override outside 60 minute window with justifiable reason (e.g. patient off unit) ..."

Review on January 16, 2019, of MR4 revealed MR4 was ordered the following medications to be administered at 2100 on January 5, 2019: ciprofloxacin (antibiotic) 250 (milligrams) mg by mouth, Famotidine (medication to treat ulcers) 20 mg by mouth, Montelukast (medication to treat asthma) 10 mg by mouth, pantoprazole (medication to treat gastroesophageal reflux disease) 40 mg by mouth, risperidone (antipsychotic) 0.25 mg by mouth, and sucralfate (medication to treat ulcers) 1 gram by mouth. There was nursing documentation the 2100 medications were administered late on January 6, 2019 at 00:14 due to short staffing.

Interview on January 16, 2018, at approximately 2:30 PM with EMP2 confirmed there was documentation in MR4 the 2100 medications ciprofloxacin, Famotidine, Montelukast, pantoprazole, risperidone, and sucralfate were administered late on January 6, 2019 at 00:14. EMP2 confirmed there was documentation the medications were administered late due to short staffing.

Review on January 16, 2019, of MR5 revealed MR5 was ordered the following medications to be administered at 2100 on January 5, 2019: Benzonatate (cough medicine) 200 mg by mouth, guaifenesin (cough medicine) 600 mg by mouth, and methylprednisolone (steroid) 40 mg intravenously (IV). There was nursing documentation the 2100 medications were administered late on January 5, 2019 at 23:47. There was no documentation to explain the late administration.

Interview on January 16, 2018, at approximately 2:40 PM with EMP2 confirmed there was documentation in MR5 the 2100 medications Benzonatate, guaifenesin, and methylprednisolone were administered late on January 5, 2019 at 23:47. EMP2 confirmed there was no documentation to explain the late administration.

Review on January 16, 2019, of MR6 revealed MR6 was ordered the following medications to be administered at 2100 on January 5, 2019: Heparin (anticoagulant) 5000 units subcutaneously, Lantus (insulin) 50 units subcutaneously, olanzapine (antipsychotic) 5 mg by mouth, and phosphorus (supplement) 250 mg by mouth. There was nursing documentation the medications were administered late on January 5, 2019 at 2317. There was no documentation to explain the late administration.

Interview on January 16, 2018, at approximately 2:50 PM with EMP2 confirmed there was documentation in MR6 the 2100 medications Heparin, Lantus, olanzapine, and phosphorus
were administered late on January 5, 2019 at 2317. EMP2 confirmed there was no documentation to explain the late administration.

Review on January 16, 2019, of MR7 revealed MR7 was ordered the following medications to be administered at 2100 on January 5, 2019: clonidine (antihypertensive) 0.1 mg by mouth and guaifenesin (cough medicine) 600 mg by mouth. There was nursing documentation the medications were administered late on January 5, 2019 at 22:52. There was no documentation to explain the late administration.

Interview on January 16, 2018, at approximately 3:00 PM with EMP2 confirmed there was documentation in MR7 the 2100 medications clonidine and guaifenesin were administered late on January 5, 2019 at 22:52. EMP2 confirmed there was no documentation to explain the late administration.