The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

FLINT RIVER COMMUNITY HOSPITAL 509 SUMTER STREET, BOX 770 MONTEZUMA, GA 31063 March 27, 2015
VIOLATION: PROGRAM SCOPE, PROGRAM DATA Tag No: A0273
Based on record review, the hospital failed to maintain an monitoring program.

Findings include:

Cross Reference

482.23 (b)(3) Supervision of Nursing Care
482.24 (c)(1) Content of Record: Orders Dated and Signed
482.41 (a) Maintenance of Physical Plant
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record review, Registered Nurses failed to supervise and evaluate the level of observation needed to assure that a patient at risk to self and others were protected for ten (10) of the ten (10) sampled patients.

Findings include:

Review of ten (10) medical records revealed:

Patient #1, admitted [DATE] with diagnosis of psychosis. Electronic physician orders failed to contain a observation level order.

Patient #2, admitted [DATE] with diagnosis of depression. Electronic physician orders failed to contain a observation level order. Observation flow sheets failed to indicate patient observation level on 3/12/15 and 3/14/15 7:00 PM- 6:45 AM, 3/17/15 7:00 AM- 6:45 PM, and 3/19/15 7:00 PM- 6:45 AM.

Patient #3, admitted [DATE] with diagnosis of substance abuse. Electronic physician orders failed to contain a observation level order. The medical record did not contain Observation flow sheets.

Patient #4, admitted [DATE] with diagnosis of psychosis. Electronic physician orders failed to contain a observation level order. Observation flow sheets failed to indicate patient observation levels on 7:00 PM- 6:45 AM shift for dates: 2/21/15, 2/22/15, 2/24/15, 2/26/15, 3/3/15, 3/5/15, and 3/8/15. Documentation on 2/23/15 7:00 AM- 6:45 PM, did not include documentation from 6:00 PM-6:45 PM. Observation documentation was performed every fifteen (15) minutes on all flow sheets.

Patient #5, admitted [DATE] with diagnosis of schizophrenia. Electronic physician orders failed to contain a observation level order. Observation documentation was marked as level 3, and performed every fifteen (15) minutes on all flow sheets.

Patient #6, admitted [DATE] with diagnosis of psychosis. Electronic physician orders failed to contain a observation level order. Observation documentation was performed every fifteen (15) minutes on all flow sheets, but failed to indicate patient observation level on:
3/17/15 7:00 PM- 6:45 AM
3/18/15 7:00 AM- 6:45 PM
3/19/15 7:00 PM- 6:45 AM
3/20/15 7:00 AM- 6:45 PM
3/22/15, 3/24/15, and 3/26/15 7:00 PM- 6:45 AM

Patient #7, admitted [DATE] with diagnosis of psychosis. Electronic physician orders failed to contain a observation level order. Observation flow sheets failed to indicate patient observation levels on 7:00 PM- 6:45 AM shift for dates: 2/11/15, 2/13/15, 2/14/15, 2/15/15, 2/16/15, and 2/20/15. Observation documentation was performed every fifteen (15) minutes on all flow sheets

Patient #8, admitted [DATE] with diagnosis of schizophrenia. Electronic physician orders failed to contain a observation level order. Observation flow sheet indicated patient was observation level 3, and documentation was performed every fifteen (15) minutes.

Patient #9, admitted [DATE] with diagnosis of dementia. Electronic physician orders failed to contain a observation level order. Observation flow sheets failed to indicate patient observation levels on 7:00 PM- 6:45 AM shift for dates: 2/20/15, 2/25/15, 2/27/15, 2/28/15, 3/1/15, 3/2/15, and 3/4/15. Observation documentation was performed every fifteen (15) minutes on all flow sheets.

Patient #10, admitted [DATE] with diagnosis of schizophrenia. Electronic physician orders failed to contain a observation level order . Observation flow sheets failed to indicate patient observation levels on 7:00 PM- 6:45 AM shift for dates: 2/13/15, 2/14/15, 2/15/15, and 2/20/15;
On 2/21/15 no staff initials were documented from 7:45 AM-10:45 AM on the flow sheet
No observation level documented on 2/22/15 7:00 AM- 6:45 PM
Observation documentation was performed every fifteen (15) minutes on all flow sheets.

Review of facility policy titled Patient Classification System for Psychiatry, effective 01/2013, revised 12/17/2014, revealed that patients are placed on one of the following levels on admission and the level is adjusted throughout their stay by the treatment team, which included:
Level One: staff observes patient's whereabouts on the unit every 30 minutes
Level two: staff observes patient's whereabouts on the unit every 30 minutes
Level three (close observation including suicide and violent precautions): staff observes patient's whereabouts on the unit every 15 minutes. This is the standard observation level of all new patients.
Level four (constant observation, including elopement precautions): patient must be maintained within the visual contact of the staff at all times. Staff documents observation every fifteen minutes.
Level five (1 on 1): one staff member must maintain the patient with the visual contact at all times, including during sleep. Staff documents observation every fifteen minutes.