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OCEANS BEHAVIORAL HOSPITAL OF PERMIAN BASIN 3300 S FM 1788 MIDLAND, TX 79706 Sept. 18, 2018
VIOLATION: PATIENT RIGHTS: INFORMED CONSENT Tag No: A0131
Based on a review of facility documentation, observation and staff interview, the facility failed to ensure each patient received accurate and complete information regarding his or her psychoactive medications from the treating physician, including the reason for the medication, desired effects and potential side effects, for 5 of 10 patients [Patients #1, #5, #7-8 and #10].

Findings were:

Facility policy #MM-02 entitled "Psychoactive Medication Administration/Consent - Texas," last revised 02/01/2017, included the following:
"PURPOSE:
To ensure the safe, appropriate, and accurate administration and handling of medications. To provide a process for ensuring patients and/or families are involved in decisions about care, treatment and services.
POLICY: Medications are administered to patients by qualified licensed personnel in compliance with regulatory bodies after verbal informed consent has been provided by the patient ...If psychoactive medications are prescribed by a LIP (Licensed Independent Practitioner), a written informed consent must be obtained from the patient or legally authorized representative ...
Only licensed prescribers are allowed to provide orders for medications. All medications require an order which is written on the physician/LIP order form ...
3. The prescriber and nurse provide education to the patient and the patient's legally authorized representative in nontechnical language in the patient's primary language.
If the information is not provided by the treating physician, the physician must confirm the explanation with the patient and the patient's legally authorized representative within two working days ..."

As an example, Patient #1 signed consents to be administered the psychoactive medications of clonazepam (anti-anxiety medication) and two consents for Cymbalta (anti-depressant medications) at different dosage levels. The consent to be administered clonazepam was signed by the patient on 5/26/18 at 10:00 a.m. The physician signed that he/she had reviewed the medication information provided Patient #1 regarding expected beneficial effects, side effects, alternative forms of treatment and medications risks on 6/22/18 at 1:40 p.m. The consents for Cymbalta had been signed by the patient on 5/24/18 at 6:10 p.m. The physician signed that he/she had ensured accurate information regarding this medication was provided to the patient on 6/20/18 at 11 p.m. Patient #1 was discharged from the facility on 5/28/18.

The above findings were confirmed in an interview with the facility Program Director and other administrative staff on the afternoon of 9/18/18 in the facility meeting room.