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 July 21, 2016
VIOLATION: PATIENT RIGHTS: NOTICE OF RIGHTS Tag No: A0117
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

The hospital failed to provide patients or their representatives a second Important Message from Medicare.
Patient #6 was admitted on [DATE] to the medical surgical unit. Patient #6 was discharged on [DATE]. No second important message was provided to the patient within two days of discharge.
Patient #8 was admitted on [DATE] to the medical surgical unit. Patient #8 was discharged on [DATE]. No second important message was provided to the patient within two days of discharge.
Patient #9 was admitted on [DATE] to the medical surgical unit. Patient #9 was discharged on [DATE]. No second important message was provided to the patient within two days of discharge.
Patient #11 was admitted on [DATE] to the medical surgical unit. Patient #11 was discharged on [DATE]. No second important message was provided to the patient within two days of discharge.
Patient #12 was admitted on [DATE] to the medical surgical unit. Patient #12 was discharged on [DATE]. No second important message was provided to the patient within two days of discharge.
VIOLATION: PATIENT RIGHTS: INFORMED CONSENT Tag No: A0131
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of 6 open and 6 closed medical records it was determined that the hospital failed to provide patient #2 the right to refuse medications.
Patient #2 presented to the ED with suicidal ideations, bizarre behavior, and paranoia on 07/20/2016 at 0016. Patient #2 was given 1mg Ativan Intramuscular at 0026 and 5 mg Haldol Intramuscularly at 0026. There was no indication or rationale documented for administering of medication. There was no other option than intramuscularly ordered, which did not give patient #2 the right to refuse the intramuscular route of the medication.
Based on review of 6 open and 6 closed medical records it was determined that the hospital failed to certify if 3 patients were capable of medical decision making before using a surrogate decision maker.

Patient #1 was admitted on [DATE]. Patient #1 has a history of dementia. The hospital has been using family member for medical decision making. No capacity statements were done to determine if patient #1 is capable of making their own medical decisions.

Patient #8 was admitted on [DATE]. Patient #8 has a history of dementia presented with altered mental status. The hospital has been using family members for medical decision making. No capacity statements were done to determine if patient #8 is capable of making their own medical decisions.

Patient #11 was admitted on [DATE] with altered mental status and Spanish speaking. The hospital has been using family member for medical decision making. No capacity statements were done to determine if patient #11 is capable of making their own medical decisions.
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of 6 open medical records reviewed it was determined that the hospital failed to adequately assess a patient's wound upon admission.

Patient #8 was sent to hospital from facility for altered mental status on 6/21/2016. Patient #8 was admitted to the medical-surgical unit for possible metabolic [DIAGNOSES REDACTED], possible pneumonia, and dehydration.

In the Emergency Department (ED) the physician assessed the patient's skin to be intact. The RN in the ED also assessed the patient to not have any skin abnormalities. It was documented in the ED that patient #8 had a history of a stage III pressure ulcer, with no location documented.

The History and Physical done on 06/21/2016 did not assess the patient as having any wounds. The initial Braden score (at risk for pressure ulcer scale) done on 6/21/2016 at 1805 assessed patient #8 to have a score of an 8. This classifies the patient to be very high risk for pressure ulcers.

A Braden score was not completed daily as required by the Wound Care Policy. The Braden score was completed 6/21/2016, 6/23/2016, and 6/24/2016.

A wound consult was not ordered until 6/23/2016. The wound care nurse came to assess the patient on 6/24/2016 and stated that the patient had a chronic wound to the sacrum. The Wound care nurse assessed the patient to have a chronic (old) wound to sacrum and incontinence dermatitis. Pressure ulcer was a stage III (healing) measuring 2x2x.5cm. 6/24/2016 the patient was started on wound care. The wound care nurse ordered to cleanse wound with normal saline, place silvasorg Ag+ in wound bed and covered with bordered dressing. Change daily and as needed. Place Mepilex sacral dressing over sacral area. Turn and position every 2 hours as tolerated by patient. Pillow between need (sp), do not diaper, gentle clean after incontinent episode with foam cleanser and apply barrier cream.

Patient #8 was discharged back to the facility they presented from on 6/26/2016. At time of discharge the plan for discharge was discussed with the family. The family was unaware that patient #8 had a pressure ulcer to the sacrum and was receiving wound care.

The wound was not photographed until the date of discharge on 6/26/2016. Per policy the wound should have been photographed on admission, recognition, on Tuesdays, and at discharge.

Without assessing the wound early in patient #8's admission, the patient was unable to receive timely care consults and interventions in wound care.