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.

EMERSON HOSPITAL - 133 OLD ROAD TO 9 ACRE CORNER W CONCORD, MA 01742 June 8, 2011
VIOLATION: PATIENT SAFETY Tag No: A0286
Based on review of 11 medical records, the Hospital failed identify a physician order was not documented for a Soma Bed (a restraint) in two of 11 records reviewed.

Findings included:

1.) The Hospital failed to identify stickers required for use of a restraint (use of Soma bed) were not signed by a physician.

2.) Review of Hospital policies and procedures for restraints indicated the use of a restraint must be authorized by a physician or Licensed Independent Practitioner affiliated with the Hospital.
VIOLATION: MEDICAL RECORD SERVICES Tag No: A0450
Based on documentation review the Hospital failed to ensure that a physician's order was obtained per policy for each physical restraint applied to two of eleven patient records reeviewed (Patient #10 and #11).

Findings included:

1.) Review of Hospital policies and procedures for restraints indicated the use of a restraint must be authorized by a physician or Licensed Independent Practitioner affiliated with the Hospital.

2.) Medical record documentation dated 3/2/11, indicated that Patient # 10's record contained a sticker used for restraint orders. The sticker indicated the type of restraint was for an enclosure bed, however the order was not signed by a physician.

3.) Medical record documentation dated 4/28/11, indicated that Patient #11's record contained a sticker that was used for restraint orders. The sticker dated 4/28/11 was not signed by a physician.
VIOLATION: NURSING CARE PLAN Tag No: A0396
Based on interview and documentation review the Hospital failed to ensure that the plan of care was updated for 1 of 11 patients (Patient #1).

Findings included:

1.) Review of medical record documentation indicated that upon admission Patient #1 was assessed to have a severe developmental disability and was non verbal.

2.) Review of the Care Plan indicated a plan for an Orthopedic patient and the documented goal was that Patient #1's activity level will be optimized. Patient #1's plan of care was not individualized and updated to include interventions required for activities of daily living such as bathing and toileting because of Patient #1's developmental disabilities. Also, Patient #1's behavior of noncompliance with nursing care, was not identified in Patient #1's care plan.

3.) The plan of care did not include to feeding meals to Patient #1, as identified on the initial nursing assessment, dated May 11, 2011.
VIOLATION: PROGRAM SCOPE, PROGRAM DATA Tag No: A0273
Based on review of 11 medical records, the Hospital failed identify a physician order was not documented for a Soma Bed (a restraint) in two of 11 records reviewed.

Findings included:

1.) The Hospital failed to identify stickers required for use of a restraint (use of Soma bed) were not signed by a physician.

2.) Review of Hospital policies and procedures for restraints indicated the use of a restraint must be authorized by a physician or Licensed Independent Practitioner affiliated with the Hospital.