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|ADVENTIST HEALTHCARE SHADY GROVE MEDICAL CENTER||9901 MEDICAL CENTER DRIVE ROCKVILLE, MD 20850||July 18, 2018|
|VIOLATION: PATIENT RIGHTS: PARTICIPATION IN CARE PLANNING||Tag No: A0130|
|Based on review of hospital policy and seven open and five closed medical records, it was determined the hospital failed to uphold the patients' right to being informed and involved in their care and treatment by not providing adequate interpreter services for two out of 11 patients (pt. 5 and pt. 12).
Per hospital policy titled "Communication and Interpreter Service Policy" (Revised 01/16/17) "Under no circumstances will patients be asked to bring their own interpreters/use family members to interpret." The policy further stated, "When an interpreter encounter is completed, the date, time, name of the interpreter or agency and language will be documented in the patient's electronic medical record."
Patient #5 was a 70+ year old Spanish speaking patient who presented to the hospital after missing a couple of sessions of hemodialysis. Per "ED Note- Physician" at 20:04, under "Basic Information" it stated "daughter translating at patients request, offered cyracom" [a phone or video translation service]. It was not clear in this note how the ED provider established this baseline or how they knew this was the patient's desire without obtaining an interpreter.
Patient #5 was admitted to an inpatient unit later that evening. On admission, per "Nursing Admission Database" at 23:56 it was documented a Spanish telephone language line interpreter was used. There was no indication that patient #5 objected the use of an interpreter at that time. At 0:07 the same nurse documented under "Initial Admission Information" a "Qualified bilingual staff employee" was used for interpretive services for "patient assessment, plan of care conversation, counseling, test/procedures, medication instructions." However, the name of the interpreter was not documented in the medical record.
There was also no indication that interpretive services were used during patient #5's "History and Physical" at 05:49. Per another provider progress note later that morning at 11:09, an in person Spanish interpreter was used. However, the name was again not documented.
In addition, there was an Infectious disease consult note, a nephrology consult note, a case management note and provider progress notes for the next consecutive 5 days that did not reference the use of an interpreter.
A nutrition consult on the patient's third day of admission mentioned "pt indicates in Spanish that (he/she) doesn't want to eat ..." It was not clear if an interpreter was used at this time.
Aside from the nursing admission assessment, no other nursing assessments document the use of an interpreter.
A consent for hemodialysis was also found in the chart for patient's second day of admission. There was no indication that an interpreter was used to explain the consent or a note on why a family member was signing the consent and not the patient.
Per the "Acute Hemodialysis Flow Sheet," an RN documented the use of an interpreter during dialysis although an interrupter name was not provided. Patient #5 returned to dialysis 3 days later. There was no indication that an interpreter service was used at that time.
Patient #12, an elderly Vietnamese speaker, presented for a scheduled surgery. The Nursing Admission Database indicated that the patient could not read or write and preferred verbal communication in Vietnamese. However, section 5 of that assessment stated that there were no barriers to learning.
Patient #12 was hospitalized for ten days. Notes within the medical record acknowledged that the patient had a language barrier, however the medical record lacked evidence of the use of interpreter services. A translator was used for the surgical consent, however, the consent lacked the name of the interpreter or service used.
In summary, the hospital failed to obtain interpretive services for numerous interactions involving patients #5 and patient #12 and failed to adequately document how they met the care needs of these patients without using interpreters.