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LEHIGH VALLEY HOSPITAL - POCONO 206 EAST BROWN STREET EAST STROUDSBURG, PA 18301 Feb. 1, 2017
VIOLATION: EMERGENCY SERVICES POLICIES Tag No: A1104
Based on a review of facility documents, medical records (MR) and staff interview (EMP), it was determined that Pocono Medical Center failed to ensure acceptable standards of Emergency Services were provided to meet the emergency care needs of a patient presenting with alcohol abuse and intoxication, opiate drug use, depression and suicidal thoughts for one of 12 applicable medical record reviewed (MR1).

Findings include:

Review on February 1, 2017, of facility Assessment and Intervention of the Suicidal Risk Patient policy, last approved April 10, 2015, revealed, "Purpose: Pocono Medical Center clinical staff will proactively screen patients being treated for emotional or behavioral in disorders and for the risk of suicide at initial contact. Patients identified to be at risk for suicide will be further assessed. 1. To identify patients at risk for suicide in the hospital setting. 2. To meet the patient's immediate safety and assure the most appropriate setting for treatment. ... ."

Review on February 1, 2017, of facility Patient Elopement policy, effective July 8, 2011, revealed, "1. Purpose: a. It is the Policy of PMC to implement reasonable guidelines to prevent and report patient elopement. As provided in Pennsylvania law, under certain circumstances patients who have been deemed a danger to themselves and/or others can be detained involuntarily. These patients may present under one or more of the following condition, but are not limited to the following: i. Intoxicated patients ii. Patients medicated with drugs that may impair functioning iii Head injured patient or those with altered level of cognition for whatever reason iv. Psychiatric patients. 2. Guidelines a. Procedure/Responsibility/Action i. When a patient is deemed clinically to be a danger to him/her, and/or others, measures will be taken to detain that patient while care and/or evaluation are being provided. ii. A specific approach to preventing elopement is based on the patient's individual needs. iii. Measures such as the following should be considered and/or implemented by the nursing/crisis/medical staff to encourage patient compliance: 1. Providing verbal explanation, teaching or coaching on reasons to stay for treatment. 2. Placing the patient in a room directly in from of or near the nurses station. 3. Requesting the assistance of security to monitor the patient's activity. 4. Complete Crisis evaluation as soon as possible. 5. Physical controls such as locked seclusion room and/or physical restraints. The least restrictive measure should be utilized. ... ."

Review on February 1, 2017, of facility Smoke Free Campus policy, no review date, revealed, "Purpose: Pocono Health System is dedicated to improving the health of our patients and employees. We also believe in providing an environment which encourages a healthy lifestyle for our employees, medical staff, volunteers, and visitors. Allowing the use of tobacco products on the Health System campus does not portray our health System as a leader in the community, and does not promote a healthy environment. ... ."

Review on February 1, 2017, of the Manager, Safety and Security, job description, last reviewed November 10, 2015, revealed, "Job Summary: Responsible for developing, implementing and monitoring systems, programs and policies designed to promote a safe and secure environment in which to administer patient care. Coordinates activities of the Security Department to provide protective services for patients, visitors, employees and corporate assets. Major Tasks, duties, and Responsibilities: Is responsible for the development of a comprehensive physical Security program and directs operations of Security Services Department which is responsible for maintaining a safe environment for our staff, patients and visitors - 24/7. ... ."

Review of MR1 on February 1, 2017, revealed the facility admitted this patient to their Emergency Department (ED) on January 1, 2017, at 8:41 AM with alcohol abuse and intoxication for three days, opiate drug use, depression and suicidal thoughts.

Review of MR1 on February 1, 2017, revealed the following:

At 9:00 AM, MR1 was placed on suicidal prevention precautions which included: 1:1 observation for safety and changed into hospital scrubs.

At 9:07 AM the ED physician ordered nursing staff to apply restraints to MR1's both right and left arms and legs for combativeness and unable to follow commands.

Interview with EMP1 and EMP2 on February 1, 2017, at approximately 10:20 AM confirmed MR1 was admitted to the facility ED with alcohol abuse and intoxication for three days, opiate drug use, depression and suicidal thoughts; MR1 was placed on suicidal prevention precautions which included: 1:1 observation for safety and changed into hospital scrubs; and the ED physician ordered nursing staff to apply restraints to MR1's both right and left arms and legs for combativeness and unable to follow commands.

Review on February 1, 2017, of facility PHS Safety and Security Activity Log, dated January 11, 2017, revealed EMP7 was called to the ED at 9:30 AM for MR1 who was intoxicated and threatening to leave. EMP7 escorted MR1 out of the building at 9:30 AM for a cigarette.

Interview with EMP1, EMP2 and EMP7 on February 1, 2017, at approximately 11:50 AM confirmed EMP7 was called to the ED at 9:30 AM for MR1 who was intoxicated and threatening to leave, that EMP7 escorted MR1 out of the building at 9:30 AM for a cigarette. Further interview with EMP7 revealed this employee escorted MR1 to the bus stop in front of the hospital which is on a busy two lane road, for a cigarette. EMP7 revealed this employee is a Security Guard and is not trained to provide medical care or psychiatric care should a patient require this type of care.

Review on February 1, 2017, of MR1 revealed physician documentation dated January 11, 2017, at 10:32 AM instructing ED Nursing Staff to administer the following medications: Ativan (medication used to treat anxiety) 2 milligrams (mg) Intramuscular (IM) at 10:11; Benadryl (an antihistamine and anti-anxiety medication) 50 mg IM and Geodon (a medication used to treat manic depression) 10 mg IM.

Interview with EMP1 and EMP2 on February 1, 2017, at approximately 12:00 PM confirmed the physician documentation instructing ED nursing staff to administer Ativan 2 mg IM; Benadryl 50 mg IM and Geodon 10 mg IM.

Interview with CF1 and CF2 on February 1, 2107, at approximately 1:00 PM revealed any patient admitted to the ED with alcohol abuse and intoxication, opiate drug use, depression and suicidal thoughts would be placed on 1:1 observation with a sitter. CF1 and CF2 confirmed it is not facility practice to allow any patient to be escorted from the ED to the bus stop area on a busy two lane road for a cigarette due to the potential for stepping into traffic or eloping.