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.
|PINNACLE POINTE BEHAVIORAL HEALTH SYSTEM||11501 FINANCIAL CENTRE PARKWAY LITTLE ROCK, AR||July 7, 2016|
|VIOLATION: PATIENT RIGHTS: INFORMED CONSENT||Tag No: A0131|
|Based on clinical record review and interview, it was determined the facility failed to have a policy and procedure in effect for when one of one (#1) patient's guardian who refused treatment and the patient was placed on a 72-hour hold. The failed practice did not ensure the patient's physician followed an established procedure for when a patient's guardian refused treatment. The failed practice had the potential to affect all patients admitted to the facility. The findings follow:
A. Review of Patient #1's clinical record on 07/07/16 revealed the following:
1) Routine Medication Education and Consent Form revealed Patient #1's guardian initialed the form indicating "Do not start my child on any medications unless you are able to reach me first at one of the phone numbers I provided on this form. I understand that this might prevent my child from receiving needed medications for their psychiatric condition and assume responsibility for this. I have let the hospital know any medications that I have not consented to on this form. I understand that I may withdraw consent for any medication at any time by telling the physician or nurse in charge of my youth's care." The consent form was signed by the patient's guardian on 05/11/16 at 2348.
2) Physician Orders dated 05/17/16 at 1115 revealed "Zyprexa 2.5 mg (milligrams) po [by mouth] BID [two times per day] (agg [agitation]/mood), if guardian refuses, consent to treat and call in medical neglect, and notify Dr. (named) and (named)."
3) Routine Medication Education and Consent Form revealed, "Zyprexa (if guardian refuses, consent to treat and call in medical neglect and notify Dr. (named) and (named)). Consent per MD (physician) 5/17/16."
4) Medication Administration Records revealed Patient #1 received Zyprexa as ordered from 05/17/16 to 05/23/16.
5) Registered Nurse's note dated 05/17/16 at 1335 revealed, "Called Ms. (named), guardian of (Patient #1) at (number provided). Length of call was approx (approximately) 7 minutes to discuss tx (treatment). Guardian questioned Dr. (named)'s reason to prescribe the medication Zyprexa. Pt (Patient) came in with intent to harm and destroying property by the (named police department). His agg (aggression) and mood continues to be labile, argumentative and by report, he was punching walls. Explained to guardian that his anger has not been controlled without medication and he is a danger to others. It is Dr. (named)'s recommendation to start a low dose of Zyprexa to assist with his mood stabilization. She was angry and changed her information multiple times while speaking with writer, demanding to speak to the head of the hospital, stating the pt didn't have any anger problems, even after she said he needed help with his anger."
6) Family Therapy Note dated 05/18/16 revealed, "Family's Response to Intervention: G-mom (grandmother) expressed concern about pt being placed on meds (medications) and reports she wants the meds discontinued. G-mom referred several times to meds as 'witchcraft.' G-mom also complained that pt was sedated - despite the fact that he was awake, aware, able to participate in the conversation without slurring or falling asleep. Explained need for meds to help with mood and aggression. G-mom continues to refuse."
7) Physician's Orders dated 05/18/16 at 1000 revealed "Place pt on 72 hour hold 2* (secondary to) guardian refusing to comply to treatment with medication regimen. Call in and report to DHS [Department of Human Services]."
B. A request was made to the Director of Performance Improvement on 07/07/16 for a policy and procedure regarding when a guardian refuses medication for a patient and the patient was placed on a 72 hour hold. In an interview with the Director of Performance Improvement on 07/07/16 at 1115, he stated the facility went by the Arkansas law regarding protective custody. When asked for a policy and procedure on how the facility ensured physicians had a process for following the Arkansas law for protective custody, the Director of Performance Improvement stated the facility did not have a policy and procedure regarding when a guardian refused medication and the patient was placed on a 72 hour hold or protective custody.