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.

BEHAVIORAL HOSPITAL OF LONGVIEW 22 BERMUDA LANE LONGVIEW, TX May 11, 2016
VIOLATION: ORGANIZATION OF NURSING SERVICES Tag No: A0386
Based on review of policies and interviews, the director of nursing failed to manage the operation of nursing service by providing nursing staff with unapproved policies to operate by.

On 5-4-2016, Staff #2 provided a binder of Nursing Policy and Procedure. The binder contained multiple versions of the following policies:

NUR-7:002A Initial Screening and Criteria for Admission
NUR-7:002B Nursing Assessment and Admission Policy
NUR-7:037C Observation of Patients
NUR-7:042 Patient Assessment and Reassessment
NUR-7:055 Close Observation of Detoxification Patients
NUR-7:073 Detoxification from Alcohol-General Principles
NUR-7:077 Detoxification of Benzodiazepines
NUR-7:081 Detoxification from Opiates-General Principles
NUR-7:135 Designated Safety Rooms

Staff #2 verified that all of the Nursing Policy and Procedures binders in the Nursing Stations were set up this way. Staff #2 stated that the policies in all of the binders were printed front and back in book-form. In order to keep from having to reprint the entire binder, Staff #2 inserted the new policies in the front of the binders and educated staff where to find the new policies. Staff #2 verified that the new policies were the policies that nursing staff were supposed to be using.

The new policies did not have any signature verification that they had been approved by Governing Body (GB). When questioned, Staff #2 stated she thought they had been approved by GB. The policies could not be found to be approved in the GB meeting minutes. Staff #1 and Staff #3 both stated that they had been through GB and must have been left off of the typed minutes. However, neither Staff #1 nor Staff #3 provided the agenda where the policies were to be discussed at the meeting.

Staff #2 was requested to research the Nursing Policies and provide copies of only those policies that could be shown to have been approved by GB. The policies provided on 5/2/16 contained the original versions of the above listed policies. The new versions had not been approved but were in use.
VIOLATION: STAFFING AND DELIVERY OF CARE Tag No: A0392
Based on review of records and interview, the hospital failed to have the appropriate number of Registered Nurses (RNs) and Mental Health Technicians (MHTs) on duty to provide the needed care.

Review of April staffing sheets showed that the hospital failed to staff the appropriate number of RNs and MHTs on the following days:

4/2/16, Unit 2 was short one MHT needed to monitor a patient undergoing detoxification.

4/13/16, Unit 3 was short one MHT. With a census of 15, they required 3 MHTs but only had 2.

4/15/16, Unit 2's census was 21. They should have had 3 MHTs plus the increased staff to monitor detoxification patients. They only had 2 MHTs.

4/15/16, Unit 3 census was 15. They should have had 3 MHTs plus increased staff to monitor patients requiring one-to-one monitoring. They only had 2 MHTs.

4/17/16, The schedule shows that 2 patients were on one-to-one monitoring but does not indicate which unit they are on or show staff assigned to them. There were not enough MHTs listed on the staffing sheets to cover this increased need.

4/25/16, Unit 4 did not have an RN staffed for dayshift.

On 5/5/16 a review of the policy titled "Nurse Staffing Plan and Nurse Staffing Committee" revealed that the plan had been approved on 11/10/15 for the 2016 calendar year. The staffing grid that was included in the policy was titled "2015 Nursing Staffing Grid". The hospital had submitted a Plan of Correction from the previous survey in 2016 that increased staffing based on census of patients undergoing detoxification. The policy and nursing grid were not updated to include the new staffing requirements.

On 5/5/16 an interview was conducted with Staff #2. Staff #2 confirmed that the policy had not been revised. Staff #2 stated that the scheduler and House Supervisors knew the new requirement and knew to staff accordingly. Staff #2 stated they have meetings twice daily called "flash" meetings where they discuss the need for increased staffing. Staff #2 advised that Staff #33 prepared the daily staffing sheets.

An interview was conducted with Staff #33 on 5/5/16. Staff #33 confirmed that she does not have a written policy to go by telling her how to adjust the staffing for increased census of patients undergoing detoxification or how to increase staff for increased acuity such as one-to-one monitoring. The Staffing Grid for Detoxification Patients was described as follows: one nurse is added to the existing grid per 10 patients undergoing detoxification. One Mental Health Technician (MHT) is added to the existing grid for every two patients who are undergoing detoxification protocols. Staff #2 confirmed this is how they are staffing.
VIOLATION: NURSING CARE PLAN Tag No: A0396
Based on review of record, nursing care plans as part of the Interdisciplinary Treatment Team are incomplete, not updated, or kept current as new problems develop in 5 (Patient #'s 4, 5, 7, 13, and 14) of 6 charts reviewed (Patient #'s 4, 5, 6, 7, 13, and 14).

Review of Patient #4's records showed that the patient developed scratches to both shins and Triple Antibiotic Ointment and wound care orders were given on 4-27-2016. This new problem with medication and treatment was not added to the nursing plan of care in the Interdisciplinary Treatment Team record. The patient required a dietary consult due to a change in appetite related to drug use. Orders for supplemental nutrition (Ensure) were received on 4-22-2016 but the problem was not added to the nursing plan of care in the Interdisciplinary Treatment Team record.

Review of Patient #5's records showed that the patient had a history of gastric bypass. The history and physical examination completed on 4-27-2016 identified that the patient complained of nausea that was ongoing, related to the gastric bypass. The physician prescribed Zofran and noted that the patient had never taken Zofran before. This problem was not added to the nursing plan of care in the Interdisciplinary Treatment Team record. The patient fell and hit her head on 5-4-2016. She complained of continued headache and was transferred to the local emergency room . She was transferred back with discharge instructions for headache and syncope. The nursing plan of care in the Interdisciplinary Treatment Team record was not updated.

Review of Patient #7's records showed that on 3-18-16, the patient complained of difficulty sleeping and was ordered medication to help sleep. She received this medication at bedtime each night until discharge. This new problem with medication and treatment was not added to the nursing plan of care in the Interdisciplinary Treatment Team record.

Review of Patient #13's records showed that the patient was admitted for alcohol detoxification. This medical problem with treatment was not added to the nursing plan of care in the Interdisciplinary Treatment Team record.

Review of Patient #14's records showed that on 4-6-2016 the patient developed athlete's foot and was prescribed medication. This medical problem with treatment was not added to the nursing plan of care in the Interdisciplinary Treatment Team record. Review of Patient #14's records showed that the patient was admitted with orders for opiate detoxification. This medical problem with treatment was not added to the nursing plan of care in the Interdisciplinary Treatment Team record.