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.

SAINT THOMAS STONES RIVER HOSPITAL 324 DOOLITTLE ROAD WOODBURY, TN 37190 Jan. 21, 2016
VIOLATION: PATIENT RIGHTS: INFORMED CONSENT Tag No: A0131
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of facility policy, medical record review, and interview, the facility failed to inform a patient's family of an alleged abuse for 1 patient (#1) of 5 patients reviewed.

The findings included:

Review of the facility's policy Suspected Abuse on Geriatric Psychiatric Unit-Riverside last revised on 7/15 revealed "...As soon as a patient of the Riverside Center is suspected of being abused or neglected the staff will contact the Social Worker...The Social Worker will then provide the individual increased 1:1 and/or family therapeutic interventions..."

Review of the Patient Rights and Responsibilities revealed "...You have the right to be well informed about your illness and how it is being treated...you have the right to allow your family to participate in your care..." Further review revealed "...Access to Protective Services...the patient has the right to be free from forms of abuse or harassment and to have access to protective services..."

Medical record review revealed patient #1 was admitted to the facility on [DATE] with diagnoses including Major Neurocognitive Disorder due to Alzheimer's Disease and Behavioral Disturbances, Coronary Artery Disease (CAD), Dementia and Poor Cognition. Further review revealed the patient was discharged from the facility on 12/7/15.

Medical record review of a Nurse's Note dated 11/21/15 at 12:00 AM revealed "...Nurse tech that was sitting with patient and stated patient got tray off of Geri-chair and was swinging at her in the day room. Nurse Tech called out for help and all staff came to assist nurse tech and subdue patient again. Patient is now under observation with 2 nurse techs..."

Medical record review of a Social Service Progress note dated 11/23/15 at 4:24 PM revealed "...spoke with pt.'s [patient's] daughter-in-law regarding clinical condition and disposition planning. Family would like to discharge patient to an ALF [assisted living facility] to [another state] to be near family. Discussed options and offered education to family..."

Medical record review of a Social Service Progress note dated 11/30/15 at 11:53 AM revealed "...spoke with [named individual] at [named ALF]...regarding pt.'s clinical condition. Spoke with pt.'s daughter-in-law...to provide clinical updates and discuss disposition planning..."

Medical record review of a Social Service Progress note dated 12/4/15 at 2:00 PM revealed "...spoke with pt.'s daughter-in-law to advise her on incident occurring on 11/21/15 which staff member handled agitated patient inappropriately. SW [social worker] answered family's questions regarding incident..."

Medical record review of a Social Service Progress note dated 12/8/15 at 10:00 AM revealed "...family called SW to inform that patient arrived safely in [named state]. Family asked several questions regarding incident occurring on 11/21/15. SW answered all questions..."

Interview with the Nurse Manager on 1/5/16 at 8:53 AM, in the conference room, revealed the incident occurred on 11/21/15. Further interview revealed "...the LPN [Licensed Practical Nurse] and Nurse Technician [NT] came to me on Monday morning and told me about the incident...they felt the nurse's actions were inappropriate and felt like they should let me know..." Continued interview revealed "...they told me the patient was in the day room and was acting out...they said the nurse pulled the patient's arm behind his back and pushed into the wheel chair...they told the nurse she should let loose of his arm and she did..." Further interview revealed "...later the patient had another episode when the NT was in the day room with the patient...the patient had took the tray off the Geri-Chair and tried to throw it across the room...the RN [Registered Nurse] came in from behind the patient and grabbed the patient by the neck...the patient asked the nurse to let go and she would not...the nurse stated 'I'll pop your [expletive] head off'...the nurse did let go of the patient's neck..."

Telephone interview with the Social Service Director (SSD) on 1/14/16 at 2:15 PM, confirmed the SSD was in contact with the patient's family member throughout the patient's admission including after the alleged incident. Further interview confirmed "...I called the [named family] member on 12/4/15 and informed her of the incident after the investigation was completed...this was several days after the incident occurred..."

Telephone interview with the patient's family member on 1/14/16 at 3:50 PM, revealed "...the social worker did call me and told me there had been an incident on 11/21/15...this was 11-12 days after the incident and was right before he was going to be discharged ...what I cannot understand is why they did not tell us sooner about the incident..."

Telephone interview with the Administrator on 1/15/16 at 2:33 PM, confirmed the facility did not notify the patient's family member of the incident until 12/4/15 (13 days after the incident occurred). Further interview confirmed the facility failed to promptly notify the family of the patient's condition and status.