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Based on medical record review, document review, and staff interviews, the Critical Access Hospital (CAH) activity staff failed to document individual or group activities provided to swing bed patients in 5 of 5 closed swing bed patients (Patients #1, #2, #3, #4 and #5). The CAH identified an average monthly census of approximately 6 swing bed patients.

Failure to provide an activity program that meets the physical and psychosocial needs of the individual patient could potentially impede the patient's progression for attaining or maintaining the highest practicable level of well being.

Findings included:

1. Review of the Swing Bed Unit Structure and Practice Manual, approved 3/31/2010, revealed in part; "Documentation is completed in the electronic health record. Each discipline involved in the patient's care will complete their electronic care plan and update as indicated.... The Activity Coordinator by completing the Therapeutic Recreation Skilled Nursing Assessment Paper Form implements an activity plan to encourage self-care, resumption of normal activities, and maintenance of an optimal level of psychosocial functioning. The swing bed staff will assist the activity coordinator to be sure patients attend and complete activities." The manual failed to include the requirement for activity staff to participate in interdisciplinary care plan meetings.

2. Review of Patient #1's medical record revealed a physician's order for swing bed nursing services documented on 4/26/10 and a physician's order for discharge from swing bed nursing services documented on 5/8/10. Patient #1's medical record lacked documented evidence that showed staff provided individual or group activities.

3. Review of Patient #2's medical record revealed a physician's order for swing bed nursing services documented on 6/7/10 and a physician's order for discharge from swing bed nursing services documented on 6/16/10. Patient #2's medical record lacked documented evidence that showed staff provided individual or group activities.

4. Review of Patient #3's medical record revealed physician ' s order for swing bed nursing services documented on 6/21/10 and a physician's order for discharge from swing bed nursing services documented on 7/20/10. Patient #3's medical record lacked documented evidence that showed staff provided individual or group activities.

5. Review of Patient #4's medical record revealed a physician's order for swing bed nursing services documented on 6/31/10 and a physician's order for discharge from swing bed nursing services documented on 7/6//10. Patient #4's medical record lacked documented evidence that showed staff provided individual or group activities.

6. Review of Patient #5's medical record revealed a physician's order for swing bed nursing services documented on 4/19/10 and a physician's order for discharge from swing bed nursing services documented on 5/1/10. Patient #5's medical record lacked documented evidence that showed staff provided individual or group activities.

7. During an interview on 8/25/10 at 3:35 PM, the Medical/Surgical Nursing Manager verified Patient #1, #2, #3, #4 and #5's medical records lacked documented evidence of individual or group activities. The Medical/Surgical Nursing Manager stated, "Activity progress accountability is with the activity director and her assistant. It's collaborative but it is their responsibility to document."

8. During an interview on 8/26/10 at 8:25 AM, the Activity Director verified Patient #1, #2, #3, #4, and #5's medical records lacked documentation of individual or group activities provided to swing bed patients in the multidisciplinary care plan. The Activity Director stated, "Currently it is not a part of the interdisciplinary plan of care. I am not documenting this in the patient's medical record on a consistent basis in activity progress notes. The Activity Director reported that he/she did not participate or attend care planning conferences. He/she stated, "If there's an issue I do, but otherwise not. I communicate with nursing and social services [about the patient's activity interests] but I'm not documenting this." The Activity Director also verified that Patient #1, 2, 4, and 5's medical records lacked documented evidence of an activities reassessment. The Activities Director stated, "I assess swing bed patients 1-2 times a week. This would be documented in the activities progress notes. I failed to document this for [patient's 1, 2, 4, and 5], you are correct. the patient's may have been offered activities but there is no documentation to verify this."

Based on medical record review, document review, and staff interviews, the Critical Access Hospital (CAH) activity staff failed to include Swing Bed (SWB) patients in the comprehensive, multidisciplinary care plan process. Problems identified with 5 of 5 closed swing bed patients medical records (Patients #1, #2, #3, #4 and #5). The CAH identified an average monthly census of approximately 6 swing bed patients.

Failure to include the activity program in the care plan could potentially impede the patient's progression for attaining or maintaining the highest practicable level of well being.

Findings included:

1. Review of the Swing Bed Unit Structure and Practice Manual, approved 3/31/2010, revealed in part; "Documentation is completed in the electronic health record. Each discipline involved in the patient's care will complete their electronic care plan and update as indicated.... The Activity Coordinator by completing the Therapeutic Recreation Skilled Nursing Assessment Paper Form implements an activity plan to encourage self-care, resumption of normal activities, and maintenance of an optimal level of psychosocial functioning. The swing bed staff will assist the activity coordinator to be sure patients attend and complete activities."

The manual failed to include the requirement for activity staff to include activities in the comprehensive, multidisciplinary care plan process or participate in interdisciplinary care plan meetings.

2. Review of Patient #1's medical record revealed a physician's order for swing bed nursing services documented on 4/26/10 and a physician's order for discharge from swing bed nursing services documented on 5/8/10. Patient #1's medical record lacked documented evidence of an activity care plan.

3. Review of Patient #2's medical record revealed a physician's order for swing bed nursing services documented on 6/7/10 and a physician's order for discharge from swing bed nursing services documented on 6/16/10. Patient #2's medical record lacked documented evidence of an activity care plan.

4. Review of Patient #3's medical record revealed physician's order for swing bed nursing services documented on 6/21/10 and a physician's order for discharge from swing bed nursing services documented on 7/20/10. Patient #3's medical record lacked documented evidence of an activity care plan.

5. Review of Patient #4's medical record revealed a physician's order for swing bed nursing services documented on 6/31/10 and a physician's order for discharge from swing bed nursing services documented on 7/6//10. Patient #4's medical record lacked documented evidence of an activity care plan.

6. Review of Patient #5's medical record revealed a physician's order for swing bed nursing services documented on 4/19/10 and a physician's order for discharge from swing bed nursing services documented on 5/1/10. Patient #5's medical record lacked documented evidence of an activity care plan.

7. During an interview on 8/25/10 at 3:35 PM, the Medical/Surgical Nursing Manager verified Patient #1, #2, #3, #4 and #5's medical records lacked documented evidence of an activity care plan. The Medical/Surgical Nursing Manager stated, "Activity progress accountability is with the activity director and her assistant. It's collaborative but it is their responsibility to document."

8. During an interview on 8/26/10 at 8:25 AM, the Activity Director verified Patient #1, #2, #3, #4, and #5's medical records lacked documentation of individual or group activities provided to swing bed patients in the multidisciplinary care plan. The Activity Director stated, "Currently it is not a part of the interdisciplinary plan of care. I am not documenting this in the patient's medical record on a consistent basis in activity progress notes. The Activity Director reported that he/she did not participate or attend care planning conferences. He/she stated, "If there's an issue I do, but otherwise not. I communicate with nursing and social services [about the patient's activity interests] but I'm not documenting this."