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BROWN COUNTY COMMUNITY TREATMENT CTR 3150 GERSHWIN DRIVE GREEN BAY, WI 54311 June 12, 2013
VIOLATION: PATIENT RIGHTS: INFORMED CONSENT Tag No: A0131
Based on MR review, P&P review and interview with staff (A, D), in 1 out of 10 MR reviewed (Pt #1) the facility failed to ensure consents are signed prior to administering psychiatric medications. This deficiency potentially affects all Pts receiving psychiatric medications at this facility.

Findings include:

The facility's P & P titled "Informed consent for Medication" dated 3/2012 reviewed on 6/12/2013 at 3:30 PM indicates that it is the facility's policy to establish the rights of clients to make decisions regarding their health care treatment.

The policy states in part, "1) The physician prescribing the medication or treatment has the responsibility for giving the necessary information to the client so that an informed decision can be made. 2) Informed consent will be obtained for any medication prescribed for a psychiatric condition...... 4) ...... Consent forms are the evidence that this communication took place."

This policy also states, "The physician will fill in the blank sections of the Informed Consent form, which can then be signed by the client. The form should be signed by the physicians as evidence that the information was given."

Per review of Pt # 1's MR completed on 6/12/2013 at 10:00 AM Pt #1 was prescribed Navane (a psychotropic medication) on 4/17/2013. An informed consent for this medication was not filled out by the physician or signed by Pt #1.

During an interview with DON D and MSW A on 6/12/2013 at 3:00 PM DON D stated "there is no signed consent from the patient. The medication was ordered on 4/17 and there was no documentation this medication was discussed with the Pt."