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.

Based on records reviewed and interviews the Hospital failed to ensure for one (Patient #8) of ten medical records sampled that the Nursing Staff kept current Patient #8's Nursing Care Plan to include recommended interventions to encourage Patient #8 to take his/her antipsychotic (psychiatric) medications.

Findings included:

The Hospital policy titled, Assessment & Care Planning, undated, indicated a plan of care was updated and revised based on reassessments information.

The History and Physical, dated 8/23/17, indicated Physicians admitted Patient #8 to the Hospital from a Psychiatric Hospital for treatment of pneumonia in both lungs. The History and Physical indicated Patient #8 suffered from an exacerbation of mental illness with catatonia (unresponsiveness). The History & Physical indicated Patient #8 was refusing to take his/her antipsychotic medications.

The Medical Record indicated Rogers guardianship (a Court determined Patient #8 incapacitated and required guardianship to make medical and personal decisions) and Rogers guardianship hearing to authorize antipsychotic (psychiatric) medications.

Physician notes, dated 8/26/17 at 3:02 P.M., 8/27/17 at 12:05 P.M., 8/28/17 at 2:07 P.M., and 8/29/17 at 9:51 A.M., indicated Hospitalist #1 spoke with Patient #8's Guardian on 8/26/17 for the possible need for physical restraint for safety and medications and the Guardian agreed with the plan.

The Surveyor interviewed Hospitalist #1 at 3:40 P.M. on 10/24/17. Hospitalist #1 said that he discussed the possible need to use physical restraint to give Patient #8 his/her antipsychotic medications with Patient #8's guardian and Patient #8's guardian consented to this plan.

Nursing Notes, dated 9/1/17 at 4:03 P.M., 9/2/17 at 2:00 P.M. & 10:27 P.M., indicated Patient #8 would be restrained if he/she refused to take his/her medications.

The Surveyor interviewed the Risk Prevention Director at 4:10 P.M. on 10/14/17. The Risk Prevention Director said an Ethics Consult Plan recommended that the Nursing Staff use ice-cream, walks and fashion magazines to encourage Patient #8 to take his/her medication in an effort to avoid physical restraint.

The Ethics Consult, dated 9/6/17, indicated identified interventions to manage Patient #8's frequent refusal to take his/her medications due to his/her fear and paranoia included using a direct approach and limit negotiating such as Patient #8's own clothes and personal items from home to normalize his/her environment, encouraging walks in the hall, Patient #8's enjoyment of fashion magazines, classical music and all kinds of ice-cream.

The Assessment & Care Planning Policy indicated the plan of care was customized (individualized) based on interventions.

The Risk Prevention Director said the Nursing Staff did not individualize Patient #8's Nursing Care Plan (to include the use of ice-cream, walks and fashion magazines as encouragement for Patient #8 to hake his/her medication).

The Nursing Care Plan, dated 9/15/17 at 2:34 A.M., did not indicate the identified nursing interventions to use ice-cream, walks or fashion magazines as activities to encourage Patient #8 to take the antipsychotic medications for treatment of Patient #8's psychiatric disease.