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Based on document review and interview, it was determined that for 1 of 1 (Pt. #1) patient records reviewed for alleged injury, the Hospital failed to ensure that care in a safe setting was provided, by not using safe and appropriate de-escalation techniques for a verbally aggressive patient.

Findings Include:

1. On 7/29/2020, the CPI [Crisis Prevention Institute] workbook was reviewed. The CPI workbook included, " ...Two Forms of Aggressive Behavior ...Physical interventions are used only to manage physical risk behavior and only when all other nonphysical approaches have been exhausted."

2. On 7/30/2020, the Hospital's policy titled, "Code Green", dated 2/2020, was reviewed and included, "Procedure: 1. Staff will page a "Code Green" over the intercom system when additional staff is required for a crisis or the potential of a crisis which may consist: -combative patient *Patient threatening self or others *patient destroying property."

3. On 7/29/2020, Pt. #1's clinical record was reviewed. Pt. #1 was admitted on 7/6/2020, with a diagnosis of major depressive disorder and paranoia.
-The Nursing Progress note dated 7/12/2030 at 23:34 (11:34 PM) written by the 4 East Charge Nurse (E #4), included, "Reportedly, patient [Pt. #1] was antagonizing a peer in the day room during dinner time, staff [E #1] redirected Pt [Pt. #1] to leave the day room, patient [Pt. #1] refused to leave, staff pulled patient out his chair, patient [Pt. #1] walked out of the dayroom, patient [Pt. #1] reported that staff grabbed him by left arm and attempted to push patient [Pt. #1] to the hall, patient [Pt. #1] noted that in the process patient's [Pt. #1] right arm got injured, writer quickly assessed patient [Pt. #1] ...there was no apparent injury, skin was intact, no discoloration, no skin break, patient [Pt. #1] able to move his right hand ..."
-The Psychiatric/APN [Advanced Practice Nurse] progress note dated 7/13/2020 at 1:53 PM, included, " ...patient [Pt. #1] states that last night apparently there was an incident where a staff member had allegedly been physically aggressive with the patient [Pt. #1] and patient [Pt. #1] reported forearm pain ..."

4. On 7/29/2020 at 11:00 AM, with the Risk Manager (E #3) and Senior Verbal De-escalation Specialist (E #2), the videotape footage (camera 4.19) in the 4 East dayroom on 7/12/2020 at 5:59 PM was reviewed. Pt. #1 was observed sitting in a chair against the center back wall of the common dayroom. Pt. #1 was seen talking while sitting in his chair, but it was not clear who Pt. #1 was talking to. The Behavioral Health Technician (E #1) was sitting in a chair behind a desk at the front of the dayroom near the entrance. E#1 was seen talking while sitting in his chair, but it was not clear who E #1 was talking to. At 6:04:43, E #1 got up from the chair at the front of the dayroom and walked to back of the dayroom where Pt. #1 was sitting. E #1 grabbed Pt. #1's left arm and pulled Pt. #1 up from the chair. E #1 escorted Pt. #1 to the door at the front of the dayroom. At 6:05:19, E #1 returned to the dayroom. The videotape footage (camera 4.21) in the 4 East dayroom doorway, on 7/12/2020 at 6:05:02, showed Pt. #1 lean backward into E #1 while E#1 was trying to open the door to remove Pt. #1 from the dayroom. Pt. #1 then leaned forward with his left shoulder against the frame of the door and bent over while holding his right arm. E #1 was not observed pushing Pt. #1 into the door or the wall. It could not be determined from the videotape footage if the door hit Pt. #1 as it was being opened.

5. On 7/29/2020 at 11:14 AM, an interview was conducted with the Senior Verbal De-escalation Specialist (E #2). E #2 stated that Pt. #1 should not have been pulled out of the chair by his arm. E #2 stated that staff should call for other staff assistance, if there is no imminent risk, when the attempts to de-escalate a patient do not work. E #2 stated that physical contact with a patient during de-escalation should be the last resort, if a patient is a danger to self or others.

6. On 7/29/2020 at 11:33 AM, an interview was conducted with a Behavioral Health Technician (E #1). E #1 stated that he worked on 7/12/2020 during the evening shift, on the 4 East Behavioral Health Unit. E #1 stated that Pt. #1 was sitting in the dayroom verbally antagonizing another patient. E #1 stated that he made several attempts to de-escalate Pt. #1 without success. E #1 stated that he did not call for other staff assistance before attempting to physically remove Pt. #1 from the dayroom because everything happened so quickly.

7. On 7/29/2020 at 11:54 AM, an interview was conducted with the Director of Risk Management/Performance Improvement (E #4). E #4 stated that it is not okay to pull a patient by the arm, and that E #1 missed a step by not calling for staff assistance before attempting to remove Pt. #1 from the dayroom.

Based on document review and interview, it was determined that for 1 of 1 (E #1) employee reviewed for abuse allegations, the Hospital failed to protect all patients from possible abuse, by not removing E #1 from patient care immediately following an allegation of abuse.

Findings Include:

1. On 7/30/2020, the policy titled, "Prevention of Abuse and Neglect" (undated) was reviewed. The policy included, "Process: The Risk Department will proceed with Incident Managament and Investigation. This will included: *Remove accused employees from having contact with any individuals at [Hospital], when there is credible evidence supporting an allegation of abuse, pending the outcome of any further investigation, prosecution or disciplinary action against the emeployee."

2. On 7/29/2020, the Abuse/Neglect Response Plan revised by the Hospital 7/26/2019, was reviewed. The plan included, "If allegation is toward an employee: Remove the employee from the unit immediately. Interview staff member and document the employee's description of events. Place the employee on administrative leave pending investigation of the incident."

3. On 7/29/2020, Pt. #1's clinical record was reviewed. Pt. #1 was admitted on 7/6/2020, with a diagnosis of major depressive disorder and paranoia.
-The Nursing Progress note dated 7/12/2030 at 23:34 (11:34 PM) written by the 4 East Charge Nurse (E #4), included, "Reportedly, patient [Pt. #1] was antagonizing a peer in the day room during dinner time, staff redirected Pt [Pt. #1] to leave the day room, patient [Pt. #1] refused to leave, staff pulled patient out his chair, patient [Pt. #1] walked out of the dayroom, patient [Pt. #1] reported that staff grabbed him by left arm and attempted to push patient [Pt. #1] to the hall, patient [Pt. #1] noted that in the process patient's [Pt. #1] right arm got injured, writer quickly assessed patient [Pt. #1] ...there was no apparent injury, skin was intact, no discoloration, no skin break, patient [Pt. #1] able to move his right hand ..."
-The Psychiatric/APN [Advanced Practice Nurse] progress note, dated 7/13/2020 at 1:53 PM, included, " ...patient [Pt. #1] states that last night apparently there was an incident where a staff member had allegedly been physically aggressive with the patient [Pt. #1] and patient [Pt. #1] reported forearm pain ..."

4. The Investigation Summary Report (undated), included, "7/12/2020 ...patient [Pt. 1] was in the dayroom at dinner time when staff [E #1] directed him to exit the dayroom due to disruptive behavior. Patient [Pt. #1] stated while staff person was escorting him his arm was injured ...7/13/2020 - Staff was placed on administrative leave the following day until investigation concluded."

5. On 7/29/2020 at 11:33 AM, an interview was conducted with a Behavioral Health Technician (E #1). E #1 stated that he worked on 7/12/2020 during the evening shift, on the 4 East Behavioral Health Unit. E #1 stated that on 7/12/2020 at around 6:00 PM, Pt. #1 was sitting in the dayroom verbally antagonizing another patient. E #1 stated that he made several attempts to de-escalate Pt. #1 without success. E #1 stated that he physically escorted Pt. #1 out of the dayroom because Pt. #1 refused to leave the dayroom when asked. E #1 stated that his assignment was changed to another patient care unit on 7/12/2020, to finish his shift, after Pt. #1 alleged that E #1 physically abused him. E #1 stated that he was placed on suspension from 7/13/2020 - 7/16/2020 while the Hospital investigated Pt. #1 allegation.

6. On 7/30/2020 at 9:06 AM, an interview was conducted with the Chief Nursing Officer (E #8). E #8 stated that the policy requires that an employee that is accused of abuse towards a patient is removed from the unit where the patient is staying and not from the Hospital. E #8 stated that the Nursing Supervisor (E #9) used his nursing judgment when deciding to reassign the Behavioral Health Technician (E #1) to another patient care unit for the remainder of his shift on 7/12/2020. E #8 stated that E #1 was not removed from the Hospital immediately because the allegation of abuse was not egregious in nature, and E #1 did not have a history of abuse allegations. E #8 stated that she was confident the E #1 would not hurt any patients while completing his shift on 7/12/2020. E #8 stated that on 7/13/2020, after reviewing the videotape footage of the incident that occurred on 7/12/2020, a decision was made to place E #1 on administrative leave while an investigation was conducted.

7. On 7/13/2020, E#1 was placed on administrative leave. The allegation of abuse occured on 7/12/2020. Following the allegation of abuse on 7/12/2020, E #1 was reassigned from one patient care unit (4 East) to another patient care unit (4 West), having contact with other Hospital individuals.