HospitalInspections.org

Based upon interview and record review the facility failed to develop and implement a policy that instructs staff on how to proceed when a patient with a history of prior physical and/or sexual abuse refuses to consent to a mandatory body search in one (Patient #1) of one patients who declined the mandatory body search, but were searched, potentially resulting in emotional and psychological trauma, in a sample of 10 medical records reviewed.

Findings include:

Facility staff are unaware of what to do in the event a patient refuses the mandatory safety search. See A0144.

Based upon interview and record review the facility failed to develop and implement a policy that instructs staff on how to proceed when a patient with a history of prior physical and/or sexual abuse refuses to consent to a mandatory body search in one (Patient #1) of one patients who declined the mandatory body search, but were searched, potentially resulting in emotional and psychological trauma, in a sample of 10 medical records reviewed.

Findings include:

The facility policy, titled "Non Violent Crisis Intervention Training", not dated, revealed: "Policy: 1. [Facility name] training program is the Crisis Prevention Institute's (CPI) Nonviolent Crisis Intervention Foundation Course with Advanced Physical Skills training. 2. CPI training is required for staff having direct patient care responsibilities. Definitions: Code Security Alert-Violent Situation: A situation involving any individual(s) exhibiting or threatening violent behavior in which there is an escalating potential risk for physical harm to a patient or others and earlier interventions have been ineffective in averting the threats of harm. Procedure: 1. Initial Certification: a. All inpatient direct care and Environmental Services staff will be certified in the practice of non-harmful behavior management techniques. Certification is achieved by the completion of a Nonviolent Crisis Intervention Training Program. b. Inpatient direct care staff will be certified before completion of orientation. c. Only staff members who have completed Nonviolent Crisis Intervention Training and demonstrated competency will participate in a Code Security Alert-Violent Situation. 2. Ongoing Competency: a. Staff trained in CPI techniques will demonstrate competency by successfully completing a skills lab within 15 months of last skills check. Part of the skills lab requires return demonstration of physical techniques which are monitored by the instructors."

The facility policy, titled "Search & Seizure/Patient's & Visitor's Disposition of Contraband", not dated, revealed: "Purpose: To establish a policy that provides for a patient's and visitor's right to privacy, yet upholds the safety, security, and well-being of all patients, staff and visitors. This is to include both the search and seizure of a patient's room, person, and/or belongings, as well as search and seizure of a visitor's person and/or belongings. Definitions ...Safety Search: A search in which the patient or visitor is required to remove all of his or her clothing and put on a hospital gown. The inspection includes all emergency patients that score high risk on the Suicidal Screening Tool ....Policy: 15. At BPC (Bellin Psychiatric Center): a. A personal and belongings search and safety search will be conducted on all patients admitted to Psychiatric Intensive Care Unit (PICU), Adult & Adolescent Units, or when returning from an approved pass or unauthorized absence ....Attachment A: Patient & Visitor Explanation of Search & Seizure/Disposition of Contraband Process: [facility name] believes that each patient and visitor have a right to privacy, yet uphold the safety, security, and well-being of all patients, staff and visitors. Ensuring the safety and security of a patient and/or visit may include the search and seizure of a patient's room, person, and/or belongings....The search will be conducted by at least two members of the nursing and/or security team. The search and the result of the search will be documented in the patient's medical record." The policy failed to describe what actions staff should take in the event the required body search is refused.

The facility document, titled "Safety Search Training", revised on 5/16/2018, revealed: "Unit staff and security/second person: Wand patient after getting to unit: Check mouth, lice check. Safety search: Put on search gloves/staff remain with patient even while they are dressing. (Sic) Hold up sheet for patient privacy ...Patient to undress, remove everything except underwear and put gown on (females remove bras). To complete a skin assessment females will pull up gown up to chest but with no exposure, males pull gown up to neck. Skin Assessment includes arms and legs front and back, abdomen and back ....2nd person can search clothes inside and out. Wand clothes while removed at your discretion."

Review of Patient #1's medical record revealed: Patient #1, a 13 year old [gender] was voluntarily admitted to the Adolescent Inpatient unit on 12/20/2021 at 9:48 PM and discharged on 12/27/2021 at 11:53 AM. Intake Assessment, completed on 12/20/2021 at 10:55 PM, revealed: "Reason for admission: Patient is being referred at this time for suicidal ideations and thought disturbance. Evidenced by patient attempting to strangle [gender] with a necklace, revealing s/he is unable to be safe at home, or in the community. In addition, patient is experiencing auditory command hallucinations of 'whispers' tell patient to 'kill his/herself' and 'kill teachers.' Legal status upon admission: Voluntary....History of Trauma: The following information was gathered by patient's father. Reportedly, patient had been physical and sexually abused. [name] indicated that patient was physically abused by his/her mother, which was reported, and happened 'about 9 years ago.' In addition, patient was sexually abused by a 'family friend,' who is now in prison for the assault. This occurred 'about ten years ago.' Recommendations: Disposition: Patient will be admitted." History and Physical, completed on 12/21/2021 at 6:42 AM, revealed: "Chief complaint: Suicidal ideation, thought disturbance. Admission diagnosis/Assessment/Plan: 1. Suicidal/homicidal ideation, auditory hallucinations: Plan is per psychiatry." Nurse note, completed on 12/21/2021 at 1:23 AM, revealed: "Pt was curled up on a chair when RN (registered nurse) approached him/her to do safety search. RN explained reason for search, but pt (patient) stayed curled up and refused to acknowledge RN. RN explained the procedure and gave pt a few minutes to think about cooperating. RN and CNA (Certified Nurse Aide) approached pt again. Pt said, 'You're not taking my bra and underwear off.' RN explained the procedure again and the privacy that would be given. Pt uncurled his/her body and looked like s/he would cooperate. Pt then refused. RN explained the need for pt's cooperation and informed pt that if s/he didn't cooperate, staff would have to remove his/her clothing to do the search. RN encouraged compliance and discussed privacy issues. Pt continued to refuse. Pt was escorted to search room. Pt began swearing, hitting, kicking, trying to scratch and bite. Pt was placed in a manual hold, CPI team control position. Pt continued to be physically and verbally aggressive. Staff holding pt removed his/her clothing and checked it for contraband. Nothing was found. Pt's underwear was not removed, because to do so would be too intrusive. Pt was released when the search was completed. Pt stopped his/her aggressive behavior. RN instructed pt that s/he could get dressed and go to his/her room ....Pt was asleep by 12:45 AM. RN attempted to call parents. RN called dad at 12:30 AM and mom at 12:35 AM. Both calls went to voicemail. Message left for parents to call writer for update on pt's status. Pt has been placed on video monitoring to ensure safety. Tx (treatment) plan updated."

During an interview on 1/12/2022 at 11:55 AM, Team Facilitator (TF) Adult and Intake Unit F stated, all inpatients need to have a safety (skin) search when admitted to the unit. We take them into the search room. We ask the patient to go behind the curtain and remove all clothing except underwear, then have them put on a gown with the opening in the back. One person searches the clothes and the other uses the wand to check the body for any metal while assessing the skin and doing a lice check. If a patient refuses, we wait it out, put the patient on 1:1. It is pretty uncommon to have a patient refuse the safety search. TF F stated, "The 'Safety Search Training' is done during new employee orientation (NEO)." When asked what employees are to do if a patient refuses the safety search, TF F stated "I would wait it out, put the patient on a 1:1. Nine times out of ten, the patient cooperates."

During an interview on 1/13/2022 at 9:15 AM with Certified Nurse Aide (CNA) K stated, "I arrived on the Child/Adolescent unit around 11:00 PM (12/20/2021) and saw Patient #1 sitting on a chair with his/her head down. We (another staff member) asked him/her kindly to come in to the skin search room, we explained the purpose of the skin search and how we would allow for privacy. The more we asked the patient to cooperate, s/he became more agitated. Once RN A and CNA I came on they approached the patient again. They gave him/her a few minutes and then approached him/her again, they each placed an arm under his/her arm to escort across the hall to the search room, then the patient began kicking and screaming. I came to assist as the patient was going down to the ground, so they didn't hurt themselves while flailing about. The patient ended up kicking CNA I who fell and injured her foot. I helped CNA I out of the room and then returned to help with the skin search, by then the patient was more cooperative and the safety search was completed." When asked if he would have done anything differently in this situation, CNA K stated, "Maybe leave the patient on a 1:1 in the 'fish bowl' (hallway outside of nurse station) for the night, but that wouldn't be ideal due the potential safety risk."

During an interview on 1/13/2022 at 10:35 AM with Security guard M stated, I arrived after the event, when I entered the room the patient was lying on his/her side/back-flailing around. When asked if he would have done anything differently in this situation, Security guard M stated, "The patient has a history of abuse and I was uncomfortable with how the event unfolded."

During an interview on 1/12/2022 at 2:35 PM, Team Leader (TL) of Inpatient Nursing E confirmed that the current policy does not address what staff are to do if a patient refuses the safety search. TL E stated: "We (Team leaders and Team facilitators) have scheduled a meeting to discuss and review this policy."