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Based on record review and interviews, the facility failed to ensure a physician performed the initial psychiatric evaluation of admitting patients. The census was four.

See A1601

Based on record review and interviews, the facility failed to ensure a physician performed the initial psychiatric evaluation of admitting patients. This affected ten (Patients #1, #2, #3, #4, #5, #6, #7, #8, #9 and #10) of ten records reviewed. The census was four.

Findings include:

1. Review of patient records for Patient #2 revealed an admission date of 09/09/23 and a discharge date of 09/21/23 with diagnosis including schizophrenia. Review of admission documentation, Patient #2's initial Psychiatric Evaluation dated 09/09/23 was signed by APRN N, no physician signature was noted on the initial psychiatric evaluation.

2. Review of records for Patient #1 revealed an admission date of 10/05/23 with diagnosis of major depressive disorder. Patient #1's initial mental psychiatric evaluation was performed by a nurse practitioner (NP) not a physician.

3. Review of records for Patient #3 revealed an admission date of 08/13/23 with diagnosis of suicidal ideation. Patient #3's initial mental psychiatric evaluation was performed by a NP on 08/13/23, not a physician.

4. Review of records for Patient #4 revealed an admission date of 08/09/23 with diagnoses of bipolar and borderline personality disorder. Patient #4's initial psychiatric evaluation was performed by a NP on 08/10/23, not a physician.

5. Review of records for Patient #5 revealed an admission date of 08/13/23 with a diagnosis of bipolar disorder, manic with severe with psychotic features. Patient #5's initial psychiatric evaluation was performed by a NP on 08/13/23, not a physician.

6. Review of records for Patient #6 revealed an admission date of 07/30/23 for suicide attempt. Patient #6's initial psychiatric evaluation was performed on 07/31/23 by a NP, not a physician.

7. Review of records for Patient #7 revealed an admission date of 07/18/23 with a diagnosis of homicidal ideation. Patient #7's initial psychiatric evaluation was performed by a NP on 07/18/23, not a physician.

8. Review of records for Patient #8 revealed an admission date of 08/07/23 with a diagnosis of major depressive disorder. Patient #8's initial psychiatric evaluation was performed on 08/08/23 by a NP, not a physician.

9. Review of records for Patient #9 revealed an admission date of 10/11/23 with a diagnosis of bipolar disorder, manic. Patient #9's initial psychiatric evaluation was performed by a NP on 10/12/23, not a physician.

10. Review of records for Patient #10 revealed an admission date of 09/15/23 with a diagnosis of dementia. Patient #10's initial psychiatric evaluation was performed by a NP on 09/15/23, not a physician.

During an interview on 11/20/23 at 1:34 P.M. APRN D stated she reached out to MD C almost daily to collaborate. APRN D stated that she performed the initial assessment on Patient #10. She stated that MD C sometimes attended the treatment team meetings, but he did not sign the meeting documentation, as he was not involved in the direct care of a patient. APRN D stated she did not know of any documentation MD C signed or completed for any patient in the acute hospital.

During interview on 11/20/23 at 2:40 P.M. MD C stated that patients were required to be seen within 24 hours by a licensed provider. MD C stated he tried to see each patient as much as possible depending on the patient's stays. MD C stated he would see patients at the request of the APRNs. MD C stated that he did not document on patients that he was asked to see by APRNs, he had APRNs do the documentation. MD C stated he was at the facility two to three times a week. MD denied seeing Patient #2 during Patient #2's length of stay. MD C stated he was in a support and collaboration position.