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.

CAPE COD HEALTHCARE 88 LEWIS BAY ROAD HYANNIS, MA 02601 Feb. 3, 2011
VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING Tag No: A0144
Based on the review of 11 medical records, it was determined the Hospital failed to ensure 1 patient in need of 1:1 observation for safety was promptly placed on 1:1 observation (Patient #3).

Findings included:

Medical record documentation indicated Pateint #3 was brought to the Hospital's ED with self-inflicted left wrist lacerations requiring sutures. During triage Pateint #3 denied suicidal ideation and was assessed at low risk for suicide. Patient #3's lacerations were sutured and a behavioral health assessment was performed. Following the behavioral health assessment, the Social Worker requested further psychiatric evaluation and identified the need for 1:1 observation. Patient #3 eloped prior to the Social Worker requesting an order for 1:1 observation because the Social Worker could not connect with the ED physician.

The Hospital policy that addressed 1:1 observation indicated 1:1/constant observation was to be instituted whenever a physician/LIP believed a patient to be unsafe if unattended. The policy also indicated a RN could initiate 1:1/constant observation if he/she believed a patient to be a danger to him/herself or others. The RN must notify the nurse manager/nursing supervisor/clinical leader. The patient's attending or covering physician or LIP will be notified within one hour of the decision. The physician/LIP will provide a physician's order. The Policy did not address how if/when a physician was not available a social worker, who had performed a behavorial health assessment and determined 1:1 observation was needed, ensures the 1:1 observation is promptly initiated.