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BLOOMINGTON MEADOWS HOSPITAL 3600 N PROW RD BLOOMINGTON, IN 47404 April 12, 2017
VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING Tag No: A0144
Based on document review and interview, the facility failed to follow policy and procedure for patient rights in 1 of 10 closed Medical Records (MR) reviewed:

Findings:

1. Policy/procedure 800.22, CLIA Waived Testing Urine Pregnancy, revised/reviewed 1/17, indicated on page 2:
"nursing staff will instruct patient on procedure and purpose of the test."

2. Policy/procedure 702.04, Patient Belongings, revised/reviewed 1/17, indicated on page 4: "at discharge, technicians will need to review the patient's belongings and list on the discharge belongings list what belongings patient will be returning home with. RN will review belongings list with the patient/family. Ensure that all belongings are present. Staff and patient/family will sign each belongings record. Return the signed copies to the chart."

3. Review of Admitting Physician Orders dated 3/29/17 at 1935 hours per medical staff 2 indicated a urine pregnancy test and urine drug screen were ordered

4. Review of CLIA Waived Testing Results Form and Urine Drug Screen Form indicated a urine specimen was obtained from patient 1 on 3/29/17 at 2200 hours.

5. Review of Patient Belongings Records- admitted d 3/29/17 indicated documentation of 9 hygiene items with patient on Admission. Review of Patient Belongings Records - Discharge form lacked documentation of items returned to patient.

6. On 4/12/17 at approximately 1245 hours, staff N1 (Chief Nursing Officer) was interviewed and confirmed a urine specimen was obtained from patient 1 on 3/29/17. Staff N1 confirmed patient 1 was asked by staff N4 (Registered Nurse [RN]) to use a restroom in the hallway to obtain a urine specimen. Staff N1 confirmed the restroom used by patient 1 did not have a toilet and contained a shower and sink only. Staff N1 confirmed nursing staff failed to explain to patient 1 the process of providing a urine specimen resulting in the patient getting urine on himself/herself. Staff N1 confirmed the Patient Belongings Record-Discharge form lacked documentation of patient 1's belongings being returned at discharge. Staff N1 confirmed the Nursing Progress Note dated 3/29/17 lacked documentation the patient received and/or consumed a meal the evening of 3/29/17.

7. On 4/12/17 at approximately 1330 hours, staff N2 (RN Manager) was interviewed and confirmed patient 1 supplied a urine specimen at request of Staff N4 on 3/29/17. Staff N2 confirmed patient was asked to use a restroom in the hallway that did not contain a toilet. Staff N2 confirmed patient 1 had gotten urine on himself/herself while obtaining a urine specimen.