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|UNITED MEDICAL CENTER||1310 SOUTHERN AVENUE SE WASHINGTON, DC 20032||July 13, 2016|
|VIOLATION: PATIENT RIGHTS: INFORMED CONSENT||Tag No: A0131|
|Based on record review, policy review, and staff interviews, it was determined that nursing staff failed to ensure the patient ' s right to be free from neglect, as evidenced by staff failing to assist Patient #1, with positioning in the bed.
The findings include:
United Medical Center Hospital Policy #ADM 02-017, titled, " Patient Rights and Responsibilities, " last revised April 2014, stipulates, " ...PROVISIONS ...A. Patient Rights Include ...24. Be free from all forms of abuse ... "
United Medical Center Hospital Policy #ADM 03-033, titled, " Victims of Abuse, " last revised August 2015, stipulates, " ...POLICY ... staff must be able to recognize signs and symptoms of possible abuse/neglect ... I. Definitions...B. Neglect: Failure of a caregiver to provide basic needs of survival, care/services ... "
A. Patient #1 was admitted with diagnoses that included Lower Gastrointestinal Bleeding.
On July 13, 2016 at approximately 11:50 AM, review of the facility schedule on 5 West, the Progressive Care Unit, and revealed Employee #6 was the assigned nurse for Patient #1 on June 18, 2016 on the day shift; Employee #4 was the Charge Nurse on that day; and Employee #7 was the Medical-Surgical technician.
On July 13, 2016 at approximately 2:20 PM, further review of the nursing flowsheet dated June 18, 2016 at 1:28 PM and 8:19 PM revealed Patient #1 required assistance with activities of daily living and physical activity.
A telephone interview was conducted on July 14, 2016 at approximately 11:25 AM with Employee #6, who was assigned to care for Patient #1 on June 18, 2016. When queried regarding his/her knowledge of the interaction between Patient #1and Employee #7, during the work shift, Employee #6 explained that s/he was the nurse caring for Patient #1 on June 18, 2016, when the patient ' s daughter complained that Employee #7 refused to assist the patient with positioning. S/he spoke to Employee #6 about the occurrence, reported the incident to the charge nurse, and provided the patient ' s daughter with Employee #3 ' s (Nurse Manager) number, as requested.
On July 13, 2016 at approximately 11:40 AM, a face to face interview was conducted with Employee #4, regarding his/her knowledge of the interaction between Patient #1and Employee #7. Employee #4 explained that s/he was the charge nurse on June 18, 2016, when Employee #6 informed him/her that Patient #1 did not want Employee #4 as his/her " tech " (medical-surgical technician) because s/he refused to help him/her, when s/he asked to be pulled up in the bed; and s/he didn ' t like the way Employee #7 spoke to him/her. Employee #4 continued explaining that the patient ' s daughter came to him/her complaining about Employee #7. S/he followed the daughter into the patient ' s room, where s/he was informed by the patient that Employee #7 said s/he couldn ' t pull the patient up in bed and did not assist. S/he had a discussion with Employee #7 and informed him/her that s/he could not attend to the patient. Employee #7 explained that s/he did everything the patient asked of him/her. Employee #4 changed Employee #7 ' s assignment and notified Employee #3 of the incident.
On July 13, 2016 at approximately 10:00 AM, a face to face interview was conducted with Employee #3, regarding his/her knowledge of the interaction between Patient #1and Employee #7. Employee #3 explained that during rounds on June 20, 2016, Patient #1 informed him/her that on June 18, 2016, s/he asked Employee #7 to pull him/her up in bed, and Employee #7 responded, " Can ' t nobody move you. I can ' t be standing around and s/he didn ' t move me. " Employee #3 discussed the situation with Employee #7, who admitted that s/he did not assist the patient or get assistance. Employee #3 stated that s/he had a discussion with Employee #7 and shared that when a patient asks for assistance, that s/he ' s supposed to assist.
On July 13, 2016 at approximately 10:40 AM, a face to face interview was conducted with Employee #7, regarding his/her interaction with Patient #1 on June 18, 2016. Employee #7 explained that s/he was assisting a patient in the room with Patient #1, when Patient #1 asked him/her to adjust some pillows. " I adjusted the pillows and asked if there is anything else I can do before I leave; and s/he asked, why did I have to say it that way? I didn ' t say anything else. "
Employee #7 denied that Patient #1 asked for assistance to be pulled up in the bed. When asked if Patient #1 asked him/her to do something and s/he did not do it, Employee #7 responded, " Not to my knowledge. " Employee #7 admitted that Employee #4 suggested that s/he not go back into the room; however, Employee #7 denied having knowledge of the reason s/he was asked not to enter the patient ' s room. Employee #7 shared that s/he spoke with Employee #3 about being asked not to enter the patient ' s room, but denies that more information was shared with him, regarding the situation.
There was no evidence that Employee #7 provided requested care and services to ensure Patient #1 was free from neglect.
Employees #2 and 3 acknowledged the findings.