HospitalInspections.org

Based on observation, record review and interview, the hospital failed to ensure nursing staff developed and kept a current nursing care plan for three of ten patients ((Patients #1, #4, #9).

1. Patient #1 was admitted on 03/20/2023 as a result of increased mood instability to include deterioration in daily functioning. The patient had been identifying difficulties with dementia, irritability, agitation, as well as paranoia. Had been increasingly unable to care for himself, with family also unable to care for him. Had continued to indicate disturbance in thought process, with increased agitation and confusion,

2. Patient #4 was hospital admitted on 07/24/23 with Agitation, Confusion and Dementia. Despite physician and nursing assessed to be unable to independent living and recommended hospice evaluation, the patient's care plan did not evidence interventions to reflect nursing interventions to address the patient's impaired fine and gross motor skills, or his special need with eating, bathing, or incontinent care.

3. Patient #9 was hospital admitted on 07/06/23 with Aggression and Psychosis, catatonic and not moving. The patient was surveyor observed on 08/09/23 with a growth the size of a peanut shell on his left outer ear. There was evidence that the care plan addressed the patient's skin issue.



Findings included:

1. During Record Review Patient #1 was identified as receiving an order to go to the Emergency Department. Patient #1 had a experienced a stroke while in the hospital. During Record Review Patient #1 was identified as not have a reassessment completed once it was determined he would be sent out to the Emergency Department. During Record Review it was determined that the hospital was not following a nursing care-plan to meet the needs of this Patient #1. During Record Review Patient #1 had increased Blood pressure and there is no documentation of this Patients Care planning and ensuring the Patients needs are met. As during the interview it was unanswered why Patient #1 was not reassessed after waiting 2.5 hours to go to emergency department.


2. Observations on the hospital's geropsychiatric unit dining area on 08/09/23 between 1149 and 1205 reflected Patient #4 ate broccoli and breaded fish with his hands.

Record review of Patient #4's medical chart reflected the patient was hospital admitted on 07/24/23 at 2231 according to the patient's Information Sheet. Admitting diagnoses included: Unspecified Mood [Affective] Disorder.

Record review of Patient #4's Comprehensive Psychiatric Evaluation dated 07/not legible/23, time not legible reflected the patient had a "history of Dementia (Neurodegenerative Disease) ...admitted due to psychosis, confusion, irritability, agitation and aggression ...grossly confused, irritable, agitated. ... unable to take care of self ...needs to be in nursing home or memory care ..."The Mental Status Exam reflected the patient was " ...confused,, agitated ... [with] pressured speech ...impaired gross [and] fine motor activity ...poor insight [and] judgement ...incapable of independent living ..."

Patient #4's Admission Nursing Assessment dated 07/25/23 at 0510 reflected the patient was incontinent of bowel and bladder. He required "total assistance with walking, eating, dressing, bathing, and toileting." The admitting nurse noted that the patient had special needs including needing assistance with eating, bathing, incontinent care.

Physician Orders dated 07/29/23 at 1900 noted the patient was to receive an evaluation for Hospice Care.

Physician Daily Progress Note dated 08/09/23 reflected the patient was "total care."

Nursing Progress Notes dated 07/29/23 (night shift), 07/30/23 (night shift), 08/01/23 (night shift), 08/02/23 (night shift), 08/03/23 (night shift), 08/04/23 (night shift), 08/05/23 (night shift), 08/07/23 (night shift), 08/08/23 (night shift), 08/09/23 (day shift) reflected the patient was assessed to need "total care."

Patient #4's Nursing Progress Notes dated 07/29/23 at 1900 reflected total incontinent care was rendered.

Initial Treatment Plan dated 07/24/23 at 2400, the Master Treatment Plan dated 07/27/23 and its update dated 08/08/23 at 1330 did not reflect interventions to address the patient's needs for assistance with eating and incontinent care.

Personnel #6 was interviewed on 08/09/23 at 1430 regarding the patient's care plan updates for Hospice evaluation and stated, "I am sorry, it's not there."


3. Observations on the hospital's geropsychiatric unit on 08/09/23 at 1100 Patient #9 in a gerichair listening to music therapy in the dayroom.

Patient #9 was surveyor approached on 08/09/23 at approximately 1115 and asked about his stay at the hospital. The patient's answers were unintelligible. A growth the size of a peanut shell was noted on the patient's left outer ear.

Record review of Patient #9's Information Sheet reflected his 07/06/23 day of admission, timed at 1755.

Patient #9's Comprehensive Psychiatric Evaluation dated 07/07/23 at 1000 reflected diagnoses that included Aggression and Psychosis. "The patient appeared catatonic ...not moving ..."

Patient #9's Nurse Progress Notes dated 07/30/23, 08/02/23 through 08/09/23 reflected "no skin issues noted/reported."

Multidisciplinary Treatment Plan Updated dated 07/20/23 at 1330, 09[sic]/27/23 at 1330, and 08/23/23 at 1330 reflected interventions and goals to treat the patient's aggression only.

Patient #9's Problem List dated 07/19/223, untimed, identified the patient's "medical problems" as BPH (Benign Prostatic Hyperplasia or enlarged prostate gland), GERD, and Insomnia. There was no evidence of a skin growth.

Personnel #10 was asked during a personal interview on 08/09/23 at approximately 1615 regarding any note of the patient's peanut-sized growth on his left ear and stated it was not on the initial nursing assessment and "I don't see it on the care plan."

Policy:
The hospital Patient Rights Policy dated 04/2022, "Perimeter Healthcare's Policy is to preserve the patient's basic human rights during hospitalization, and that the patient's behavior, their relatives, and friends are reasonable and responsible. Patients have the right to be free from mental, physical, sexual, and verbal abuse., neglect and exploitation. All patients serviced will receive a statement as well as an oral explanation of those rights, both in their primary language and in simple non-technical terms prior to admission."

The hospital Policy on Neglect 02/2022, "Perimeter Healthcare promotes and requires professional, ethical and legal conduct of staff. The advocacy role of health care is maximized when addressing issues of conduct of staff. Perimeter Healthcare assess the care services providers will immediately report to the appropriate supervisor, manager, or department head any suspected legal, unethical and or unprofessional conduct by another individual. Illegal unethical and or unprofessional conduct by any health care service providers are prohibited and or state regulatory and legal authorities as mandated by stature, hospital policy and or regulation. It is the responsibility of all staff members and health care professionals of Perimeter Healthcare to report concerns regarding illegal, unethical and or unprofessional conduct to hospital administration."

The hospital Policy on Nursing Services 07/23, "It is our policy to adhere to the overall hospital mission statement, values and goals of Perimeter Healthcare and various state/federal regulatory services."

The hospital Policy on Nursing Services Plan for Delivery of Care 07/2023, "It is the policy of Perimeter Healthcare Nursing Services Department to provide the highest attainable quality of nursing care to all patients consistent with the mission, values, vision and goals.

The hospital Policy on Pharmacy Services Medications Ordering, Dispensing and Administration, "It is the policy of Perimeter Behavioral Hospital that all medication dispensed to nursing units will conform to all State and Federal Laws, Joint Commission Standards, and standards of good patient care;
IV. In the event that a medication is ordered and the pharmacist is not available to review the order prior to administration, the following procedure will be followed;
a.) Prior to obtaining the medication, the order must be assessed by the nurse as to whether it falls under one of the following categories below; if the attending nurse is unsure, he/she is to call the pharmacist on call or the physician for clarification.
b.) These medications that put the patient at risk or staff at risk.
1.) For 'stat' 'now' medications, the order must state 'stat now', to indicate the medication must be given immediately
2.) The order must be a medication that if not given at specified time, will affect the therapeutic blood levels of the patient's therapy.
3.) The order must be a medication that is life sustaining or one that ensures the safety of both staff and patient.
4.) The order must be an antibiotic or antiviral that if not given will result in prolonging the infection.
5.) Newly admitted patients will have medications administered per schedule and medications shall be administered as required to maintain their daily allocated medication quota.
6.) The order is for pain that, if not administered, will the patient to be uncomfortable.

The hospital Policy on Nutritional Risk Assessment and Management 07/2019, "It is the policy of Perimeter Healthcare to identify those patients with nutrition related problems and to provide appropriate nutritional interventions."
1. All patients will receive nutritional screening via the nursing section of the comprehensive assessment process.
2. The dietician may complete a more comprehensive nutritional assessment for patients determined to be at nutritional risk. Nutritional risk is the presence of one or more of the following:
A. Unintentional weight loss of 10% or more in the last month
B. Patient needs a special diet or history of previously ordered special diet for a valid medial reason.
C. Bingeing, purging, excessive exercise or laxative abuse.
D. Food Allergies
E. Poor oral intake for more than 1 week
F. Persistent/constant nausea, vomiting or diarrhea for than 3 days.
G. Diagnosis of Medical Conditions that place a patient at nutritional risk (Diabetes, Malnutrition, Congestive Heart Failure).
H. Diagnosis or History of eating disorder with the last 2 years.
I. Score of 6 or more on the nutritional screen of the nursing assessment admission.

The hospital Policy on Food and Nutrition 07/20219, "An adequate diet meeting the recommended dietary allowances for each age group as established by the US Department of Agriculture is provided to inpatients. All menus are approved and implemented by the Nutrition and Food Service Department under the supervision of a Registered Dietician. At least three meals per day are provided with no more than fourteen (14) hours between the first and third meal. Patients may be provided a pre-selected menu daily or allowed to select meal choices from a menu provided daily. The selected menus is typically sent with the meal tray. Substitutions may be provided as approved by a Registered Dietician. A Registered Dietician is available for consultation regarding special dietary needs and for nutritional assessment as identified as a need from the Nursing assessment nutrition screening section and/or treatment team planning. Snacks approved by the Registered Dietician are made available in the patient dining area at specific times per the unit schedule. Special diets and special snacks may be provided when required by patient condition."

The hospital Policy on Restraint/Seclusion 07/2023, "It is the policy of Perimeter Healthcare to create an environment that protects the patient's health and safety and preserves his or her dignity, rights, and well-being. All patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience, or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member, or others. In recognition that the patient has the right to be free of seclusion or restraint in any form that is not medically necessary; seclusion and restraint are to be used only in clinically appropriate and adequately justified situations when other less restrictive interventions have been determined ineffective or inappropriate ...Before ordering restraint or seclusion, the physician and staff must consider identified contraindications and other information and factors indicative of negative results to patient care outcomes."

The hospital Policy on Seclusion/Restraint Emergency Interventions 007/023. "The Seclusion/Restraint event is documented in each case of patient seclusion and or restraint. (Mechanical and chemical restraints are not approved treatment modalities at Perimeter Healthcare and are not to be used.) A Registered Nurse (RN) who has been trained and tested to be competent in restraint/seclusion is responsible for initiating and reviewing the Seclusion/Restraint documentation records. The RN shall be responsible for nursing assessments at a minimum of every 2 hours, for ensuring that the physician has been contacted in the appropriate time frame to obtain a renewal order if the criteria for seclusion and/or restraint continue to be met, and for supervising the observation and care provided by other assigned staff. The documentation is used to ensure the patient's rights are respected, that the patients privacy and care needs are met, and to provide means for monitoring the use of seclusion and/or restraint at Perimeter Healthcare."

The hospital Policy on Provision of Care Assessment and Reassessment of Patients 06/2022, "An accurate record of the patient's condition, care and treatment is provided through the hospital visit. Screening and admission assessments and histories are completed upon arrival to the hospital and during the admission process on the inpatient's units. Reassessments are documented at specific intervals and when there is a significant change in patient status, post procedure, etc. Patient information obtained during reassessment will be documented in the patient's medical record. The family, guardian/or legally authorized representative will be assisted to be involved throughout the assessment process and in the provision of care of the patient for all children and adolescent/youth admitted to the facility; and for all adults as is authorized and approved by the patient ...A Registered Nurse (RN) is designated as the admitting nurse and is responsible for ensuring the completion of the comprehensive nursing admission assessment. Vital signs and the completion of other routine tasks may be assigned to other nursing staff as allowed and defined by statutory regulations and the Texas Board of Nursing.
1. An RN shall conduct and complete an initial comprehensive nursing assessment of the patient (25 TAC 411.473 e)
2. Per the Texas Board of Nursing (FAQ-LVN Performing Initial Assessments): "'In situations requiring comprehensive assessments by a RN, the LVN cannot begin by performing a focused assessment and have the RN follow up with an assessment of only those parameters not assessed by the LVN. A comprehensive assessment is a different level of assessment requiring that the RN use his/her own judgement.'
3. The RN Nursing Admission Assessment is completed within eight (8) hours of admission. (TAC 411.473e).
Reassessments of patients are to be completed every shift and when there is a significant change in patient condition or status, post procedure and as warranted and/or recommended by the provider and/or treatment team.
Nursing reassessments. AN RN will reassess the patient based on the patient's needs, but at least every 12 hours after the initial comprehensive nursing assessment has been completed. (TAC 411.473f) ...Assessment and reassessment patient information are documented in the patient's medical record and are permanent parts of the patient's medical record.

The hospital Policy on Visitation 07/2023, "To facilitate continued interactions between patients and their significant others, visiting hours are scheduled everyday to provide maximum opportunity to visit patients."
The hospital policy on Assessment 07/2023;
1. Perimeter Behavioral Hospital of Dallas Administration welcomes all patients who meet criteria for admission. No patient is to be denied admission due to race, color, religion, sexual orientation, ancestry, financial class, or national origin. All patient's will be accepted for care, cared for, and housed without discrimination.
2. A patient shall only be admitted on a voluntary basis, with written consent. Exceptions to this include a patient that presents as an imminent danger to self/others and meets criteria for involuntary admission. A parent/guardian is permitted by law to provide consent for a minor child that is in their custody. Additionally, if there is a Durable/Healthcare Power of Attorney, or Conservatorship, that legally authorized persona may present paperwork to the admission department to provide consent for recommended treatment.
3. Individuals are screened for eligibility at the point of first contact with the organization, whether by phone, in person, or other.
4. After screening, an admission assessment is completed by a Qualified Mental Provider (Physician, PA, LCSW, LMSW, LPC, LPC intern, LMFT or Registered Nurse).
5. If the patient displays a mental illness requiring inpatient mental health treatment the assessment is reviewed with the admitting or on-call physician to obtain admission orders. If the patient does not require inpatient mental health treatment, then the appropriate referrals will be made at that time.
6. After screening, an assessment is completed and reviewed with the on-call physician to determine an appropriate level of care.
7. At the time of admission, information about the locations and hours during which care, treatment or services are available shall be given to each patient and/or family.

Based on observation, interview and record review the hospital failed to ensure that the registered nurse staff supervised the nursing care for two of ten patients (Patients #1, #4).

1. Patient #1 was admitted on 03/20/2023 as a result of increased mood instability to include deterioration in daily functioning. The patient had been identifying difficulties with dementia, irritability, agitation, as well as paranoia. Had been increasingly unable to care for himself, with family also unable to care for him. Had continued to indicate disturbance in thought process, with increased agitation and confusion.
2. Patient #4 was admitted on 07/24/23 from a medical hospital with diagnoses that included Unspecified Mood Disorder and neurodegenerative Dementia. Although medical and nursing staff assessed the patient to be incapable of taking care of himself and required total assistance for eating and other activities of daily living, the patient was left to eat by himself without assistive devices and ate vegetables and fish with his hands.


Findings included:

1. During Record Review Patient #1 was identified as receiving an order to go to the Emergency Department. Patient #1 had a experienced a stroke while in the hospital. During Record Review Patient #1 was identified as not have a reassessment completed once it was determined he would be sent out to the Emergency Department. During Record Review it was determined that the hospital was not following a nursing care-plan to meet the needs of this Patient #1. During Record Review Patient #1 had increased blood pressure and there is no documentation of this Patients Care planning and insuring the Patients needs are met. As during the interview it was unanswered why Patient #1 was not reassessed after wafting 2.5 hours to go to emergency department.

2. Observations on the hospital's geropsychiatric unit on 08/09/23 at 1100 reflected eight patients were in the dayroom during music therapy. Three patients were in gerichair recliners (Patients #9, #4, #28). Patients #28 and #4 appeared to be asleep with their heads back and not responding to the music. A strong urine smell was noted in the dayroom without an immediately identifiable source.

Lunch arrived on the unit on 08/09/23 at approximately 1125 which was identified by Personnel #1 as being late. Staff moved all patients except Patients #28 and #4 to the lunchroom.

On 08/09/23 at 1149, Patient #4 had been moved to the dining room and was observed eating broccoli with his hands. Personnel #11 stated at that time that they did not use plastic forks for safety reasons; staff aimed to progress the patient to "independence." At 1205 the patient was observed eating his breaded fish with his hands.

Record review of Patient #4's Information Sheet reflected the patient's 07/24/23 date of admission timed at 2231. Admitting diagnoses included Unspecified Mood [Affective] Disorder.

Patient #4's Physician's MOT Orders dated 07/24/23 at 2318 reflected his medical conditions to include Parkinson's Disease.
Patient #4's Comprehensive Psychiatric Evaluation dated 07/not legible/23, time not legible, reflected the patient's history of a Neurodegenerative Disease. He was admitted "due to psychosis, confusion, irritability, agitation and aggression ...grossly confused, irritable, agitated, ... unable to engage in any useful conversation ...unable to take care of self ..." The physician's Mental Status Exam reflected the patient was " ...confused, agitated ... impaired gross [and] fine motor activity ...poor insight [and] judgement ...incapable of independent living ..."

Record review of Patient #4's Admission Nursing Assessment dated 07/25/23 at 0510 reflected the patient was incontinent of bowel and bladder. He required "total assistance with walking, eating, dressing, bathing, and toileting." The document emphasized that the patient had special needs including needing assistance with eating, bathing, and incontinent care.

Record review of Patient #4's Physician Daily Progress Note dated 08/09/23 reflected the patient was "total care."
The findings were shared with Personnel # 1 on 08/09/23 at or around 1600 and with Personnel #10 on 08/09/23 at or around 1615.

Nursing Progress Notes dated 07/29/23 (night shift), 07/30/23 (night shift), 08/01/23 (night shift), 08/02/23 (night shift), 08/03/23 (night shift), 08/04/23 (night shift), 08/05/23 (night shift), 08/07/23 (night shift), 08/08/23 (night shift), and 08/09/23 (day shift)
reflected the patient was assessed to need "total care."

The findings were shared with Personnel #10 on 08/09/23 at approximately 1620. Personnel #10 acknowledged the findings at that time.

Policy:
The hospital Patient Rights Policy dated 04/2022, "Perimeter Healthcare's Policy is to preserve the patient's basic human rights during hospitalization, and that the patient's behavior, their relatives, and friends are reasonable and responsible. Patients have the right to be free from mental, physical, sexual, and verbal abuse., neglect and exploitation. All patients serviced will receive a statement as well as an oral explanation of those rights, both in their primary language and in simple non-technical terms prior to admission."

The hospital Policy on Neglect 02/2022, "Perimeter Healthcare promotes and requires professional, ethical and legal conduct of staff. The advocacy role of health care is maximized when addressing issues of conduct of staff. Perimeter Healthcare assess the care services providers will immediately report to the appropriate supervisor, manager, or department head any suspected legal, unethical and or unprofessional conduct by another individual. Illegal unethical and or unprofessional conduct by any health care service providers are prohibited and or state regulatory and legal authorities as mandated by stature, hospital policy and or regulation. It is the responsibility of all staff members and health care professionals of Perimeter Healthcare to report concerns regarding illegal, unethical and or unprofessional conduct to hospital administration."

The hospital Policy on Nursing Services 07/23, "It is our policy to adhere to the overall hospital mission statement, values and goals of Perimeter Healthcare and various state/federal regulatory services."
The hospital Policy on Nursing Services Plan for Delivery of Care 07/2023, "It is the policy of Perimeter Healthcare Nursing Services Department to provide the highest attainable quality of nursing care to all patients consistent with the mission, values, vision and goals.

The hospital Policy on Pharmacy Services Medications Ordering, Dispensing and Administration, "It is the policy of Perimeter Behavioral Hospital that all medication dispensed to nursing units will conform to all State and Federal Laws, Joint Commission Standards, and standards of good patient care;
IV. In the event that a medication is ordered and the pharmacist is not available to review the order prior to administration, the following procedure will be followed;
a.) Prior to obtaining the medication, the order must be assessed by the nurse as to whether it falls under one of the following categories below; if the attending nurse is unsure, he/she is to call the pharmacist on call or the physician for clarification.
b.) These medications that put the patient at risk or staff at risk.
1.) For 'stat' 'now' medications, the order must state 'stat now', to indicate the medication must be given immediately
2.) The order must be a medication that if not given at specified time, will affect the therapeutic blood levels of the patient's therapy.
3.) The order must be a medication that is life sustaining or one that ensures the safety of both staff and patient.
4.) The order must be an antibiotic or antiviral that if not given will result in prolonging the infection.
5.) Newly admitted patients will have medications administered per schedule and medications shall be administered as required to maintain their daily allocated medication quota.
6.) The order is for pain that, if not administered, will the patient to be uncomfortable.

The hospital Policy on Nutritional Risk Assessment and Management 07/2019, "It is the policy of Perimeter Healthcare to identify those patients with nutrition related problems and to provide appropriate nutritional interventions."
1. All patients will receive nutritional screening via the nursing section of the comprehensive assessment process.
2. The dietician may complete a more comprehensive nutritional assessment for patients determined to be at nutritional risk. Nutritional risk is the presence of one or more of the following:
A. Unintentional weight loss of 10% or more in the last month
B. Patient needs a special diet or history of previously ordered special diet for a valid medial reason.
C. Bingeing, purging, excessive exercise or laxative abuse.
D. Food Allergies
E. Poor oral intake for more than 1 week
F. Persistent/constant nausea, vomiting or diarrhea for than 3 days.
G. Diagnosis of Medical Conditions that place a patient at nutritional risk (Diabetes, Malnutrition, Congestive Heart Failure).
H. Diagnosis or History of eating disorder with the last 2 years.
I. Score of 6 or more on the nutritional screen of the nursing assessment admission.

The hospital Policy on Food and Nutrition 07/20219, "An adequate diet meeting the recommended dietary allowances for each age group as established by the US Department of Agriculture is provided to inpatients. All menus are approved and implemented by the Nutrition and Food Service Department under the supervision of a Registered Dietician. At least three meals per day are provided with no more than fourteen (14) hours between the first and third meal. Patients may be provided a pre-selected menu daily or allowed to select meal choices from a menu provided daily. The selected menus is typically sent with the meal tray. Substitutions may be provided as approved by a Registered Dietician. A Registered Dietician is available for consultation regarding special dietary needs and for nutritional assessment as identified as a need from the Nursing assessment nutrition screening section and/or treatment team planning. Snacks approved by the Registered Dietician are made available in the patient dining area at specific times per the unit schedule. Special diets and special snacks may be provided when required by patient condition."

The hospital Policy on Restraint/Seclusion 07/2023, "It is the policy of Perimeter Healthcare to create an environment that protects the patient's health and safety and preserves his or her dignity, rights, and well-being. All patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience, or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member, or others. In recognition that the patient has the right to be free of seclusion or restraint in any form that is not medically necessary; seclusion and restraint are to be used only in clinically appropriate and adequately justified situations when other less restrictive interventions have been determined ineffective or inappropriate ...Before ordering restraint or seclusion, the physician and staff must consider identified contraindications and other information and factors indicative of negative results to patient care outcomes."

The hospital Policy on Seclusion/Restraint Emergency Interventions 007/023. "The Seclusion/Restraint event is documented in each case of patient seclusion and or restraint. (Mechanical and chemical restraints are not approved treatment modalities at Perimeter Healthcare and are not to be used.) A Registered Nurse (RN) who has been trained and tested to be competent in restraint/seclusion is responsible for initiating and reviewing the Seclusion/Restraint documentation records. The RN shall be responsible for nursing assessments at a minimum of every 2 hours, for ensuring that the physician has been contacted in the appropriate time frame to obtain a renewal order if the criteria for seclusion and/or restraint continue to be met, and for supervising the observation and care provided by other assigned staff. The documentation is used to ensure the patient's rights are respected, that the patients privacy and care needs are met, and to provide means for monitoring the use of seclusion and/or restraint at Perimeter Healthcare."

The hospital Policy on Provision of Care Assessment and Reassessment of Patients 06/2022, "An accurate record of the patient's condition, care and treatment is provided through the hospital visit. Screening and admission assessments and histories are completed upon arrival to the hospital and during the admission process on the inpatient's units. Reassessments are documented at specific intervals and when there is a significant change in patient status, post procedure, etc. Patient information obtained during reassessment will be documented in the patient's medical record. The family, guardian/or legally authorized representative will be assisted to be involved throughout the assessment process and in the provision of care of the patient for all children and adolescent/youth admitted to the facility; and for all adults as is authorized and approved by the patient ...A Registered Nurse (RN) is designated as the admitting nurse and is responsible for ensuring the completion of the comprehensive nursing admission assessment. Vital signs and the completion of other routine tasks may be assigned to other nursing staff as allowed and defined by statutory regulations and the Texas Board of Nursing.
1. An RN shall conduct and complete an initial comprehensive nursing assessment of the patient (25 TAC 411.473 e)
2. Per the Texas Board of Nursing (FAQ-LVN Performing Initial Assessments): "'In situations requiring comprehensive assessments by a RN, the LVN cannot begin by performing a focused assessment and have the RN follow up with an assessment of only those parameters not assessed by the LVN. A comprehensive assessment is a different level of assessment requiring that the RN use his/her own judgement.'
3. The RN Nursing Admission Assessment is completed within eight (8) hours of admission. (TAC 411.473e).
Reassessments of patients are to be completed every shift and when there is a significant change in patient condition or status, post procedure and as warranted and/or recommended by the provider and/or treatment team.
Nursing reassessments. AN RN will reassess the patient based on the patient's needs, but at least every 12 hours after the initial comprehensive nursing assessment has been completed. (TAC 411.473f) ...Assessment and reassessment patient information are documented in the patient's medical record and are permanent parts of the patient's medical record.

The hospital Policy on Visitation 07/2023, "To facilitate continued interactions between patients and their significant others, visiting hours are scheduled everyday to provide maximum opportunity to visit patients."
The hospital policy on Assessment 07/2023;
1. Perimeter Behavioral Hospital of Dallas Administration welcomes all patients who meet criteria for admission. No patient is to be denied admission due to race, color, religion, sexual orientation, ancestry, financial class, or national origin. All patient's will be accepted for care, cared for, and housed without discrimination.
2. A patient shall only be admitted on a voluntary basis, with written consent. Exceptions to this include a patient that presents as an imminent danger to self/others and meets criteria for involuntary admission. A parent/guardian is permitted by law to provide consent for a minor child that is in their custody. Additionally, if there is a Durable/Healthcare Power of Attorney, or Conservatorship, that legally authorized persona may present paperwork to the admission department to provide consent for recommended treatment.
3. Individuals are screened for eligibility at the point of first contact with the organization, whether by phone, in person, or other.
4. After screening, an admission assessment is completed by a Qualified Mental Provider (Physician, PA, LCSW, LMSW, LPC, LPC intern, LMFT or Registered Nurse).
5. If the patient displays a mental illness requiring inpatient mental health treatment the assessment is reviewed with the admitting or on-call physician to obtain admission orders. If the patient does not require inpatient mental health treatment, then the appropriate referrals will be made at that time.
6. After screening, an assessment is completed and reviewed with the on-call physician to determine an appropriate level of care.
7. At the time of admission, information about the locations and hours during which care, treatment or services are available shall be given to each patient and/or family.