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.

LAUREL REGIONAL MEDICAL CENTER 7300 VAN DUSEN ROAD LAUREL, MD 20707 Oct. 11, 2012
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0175
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on a review of 9 open records and 19 closed medical records, it was determined that in 1 of the 19 closed records the hospital failed to document monitoring of the patient ' s behavior while in restraints.

Patient #11 was a [AGE] year old female who presented to the Emergency Department at Laurel Regional Medical Center on 9/9/12 for acute psychosis. Review of the closed medical record revealed that the behavioral observation flow sheet for monitoring the patient every fifteen minutes was not complete with blank spaces starting at the quarter of each hour until fifteen minutes after the hour. There was no indication regarding the patient ' s behavior for forty-five minutes before the nurse documentation regarding the patient's mental status, physical status and justification for four point restraint. The patient's behavior prior to the nurse's assessment can help the nurse make a decision on the continued need for or discontinuation of restraint. In addition the form clearly states under the behavioral observations column "(Document what you see the patient doing)."
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0187
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on a review of 9 open records and 19 closed medical records, it was determined that in 1 of the 9 open records, the hospital failed to document the patient ' s condition or symptoms that warranted the use of restraint.

Patient #3 is a [AGE] year old male who presented to the Emergency Department at Laurel Regional Medical Center on 10/10/12 after being Emergency Petitioned for erratic behavior at home and aggression. At 11:40pm the patient was transferred to a room where he was trying to get out of bed, screaming, "risk of harm to self and others." At 12:06am on 10/11/12, twenty-six minutes later the patient was placed in 2 point restraint for significant threats but this was not documented in the nursing progress note. There is no indication of the patient's plan or immediate actions that placed him at risk. The documented information does not provide the justification for restraint nor were the least restrictive interventions tried or documented prior to restraint.
VIOLATION: MEDICAL RECORD SERVICES Tag No: A0450
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

In 1 out of 9 open medical records and 6 out of 19 closed medical records selected from the hospital Emergency Department log, the hospital failed to ensure the patient transfer form was complete.

Pt. #6 was 5 years old, admitted on [DATE] at 07:36 with a diagnosis of stomach pains and constipation. The patient was stabilized and transferred at 9:30AM to CNMC in D.C. A review of the patient ' s Transfer Sheet revealed that while the physician assessed the pt. as stable and in need of special inpatient services located outside of the facility. The physician failed to complete the Risks and Benefits section.

Patientn # 11 was a [AGE] year old female who presented to the Emergency Department at Laurel Regional Medical Center on (date) for acute psychosis. The patient was brought to the Emergency Department at Laurel Regional Medical Center on 9/9/12 at 6:20pm and triaged. The patient was seen by the physician 7:24pm and transferred to another area hospital for inpatient psychiatric care on 7/10/12 at 11:30pm. The patient ' s transfer form were incomplete, the risk verses benefits were blank but signed by the physician.

Patient # 14 was a [AGE] year old female who began convulsing and drooling at a friend's home. The patient was brought into the Emergency Department at Laurel Regional Medical Center on 7/1/12 at 8:37am and triaged. The patient was seen by the physician and transferred to Children's Hospital for new onset seizures. The patient transfer form was not timed, the reason for transfer block and risk verses benefit blocks were blank.

Patient #15 was a 5 year old female who fell from a slider sustaining a fracture of the list wrist. The patient was brought into the Emergency Department at Laurel Regional Medical Center on 7/2/12 at 7:17pm. The patient was transferred to Children's hospital. The patient transfer form lacked the time of transfer and the informed consent transfer block was blank. The patient's father was in the ED with the patient and signed the general consent for treatment.

In 1 out 23 closed medical records selected from the hospital emergency department log, the hospital failed to document the time on the medical screening exam form.

Patient #13 was a [AGE] year old male who (MDS) dated [DATE] at 10:19 after a trip and fall. The patient was triaged at 10:10am. The medical screening examination form lacked a date, the provider printed name and the history block was blank regarding who the history was obtained from.

In 2 out of 19 closed medical records selected from the hospital emergency department log, the hospital failed to retain a copy of the certification documentation required for involuntary admission for the psychiatric patient. The hospital was not aware this information was missing and therefore a closed medical record was incomplete.

Patient #11 was a [AGE] year old female who presented to the Emergency Department at Laurel Regional Medical Center on (date) for acute psychosis. Review of the closed medical record revealed no copy of the application of admission, two certificates, and six questions. Per the hospital, the originals were sent to the receiving hospital without obtaining a copy for the medical record at Laurel Regional Medical Center. Therefore the hospital had an incomplete closed medical record that they were not aware of until the survey, October 11, 2012.

Patient # 12 presented to the Emergency Department at Laurel Regional Medical Center for acute psychosis. Review of the closed medical record revealed no copy of the application of admission, two certificates, and six questions. Per the hospital, the originals were sent to the receiving hospital without obtaining a copy for the medical record at Laurel Regional Medical Center. Therefore the hospital had an incomplete closed medical record that they were not aware of until the survey, October 11, 2012.

Three out of the seven closed records reviewed by this surveyor lacked completion of the risks and benefits by the physician before the patient transfer:

Patient #19 is a 16 year old, brought in by the police and admitted on [DATE] at 19:08 with suicidal ideation and cutting the wrist. A review of the Transfer Form revealed that the patient was stabilized and transferred on 09/03/12 at 2300 to Adventist Behavioral Health. The risks and benefits section of the Transfer Form was incomplete and not checked by the physician.
Patient #20 is a 14 year old, admitted on [DATE] at 18:49 for stomach pain, vomiting, and constipation. The cause of the abdominal pain was uncertain. Review of the transfer form revealed that the physician did not complete the risks and benefits section of the patient Transfer Form.
Patient #22 is a 1 year old who had incurred first and second degree burns on the left side of the neck, chest, and abdomen. The patient was admitted on [DATE] at 23:11. The patient was transferred to CNMC in D.C. on 08/10/12. Review of the Transfer Form revealed that the patient was transferred, but the time of transfer was blank. Also, the risks and benefits section of the Transfer Form were not completed by the physician.