HospitalInspections.org

Based on record review and interview, the facility failed to ensure that the name and discipline of nursing and social work staff persons responsible for specific aspects of care were listed on the multidisciplinary Master Treatment Plans for 8 of 8 active sample patients (A2, A3, A4, A5, A8, A11, A14 and A15). This practice results in the facility's inability to monitor staff accountability for specific treatment modalities.

Findings include:

A. Record Review

1. Facility policy, titled "Treatment Plan Acute Inpatient", policy number 1200.9, last reviewed 1/11, stated: "Each discipline is to document their [sic] interventions and responsible person." None of the interventions for the sample patients below contained a specific name of a staff person. Only the discipline was identified.

2. Active sample patient A2 Master Treatment Plan (MTP) dated 3/15/11
Intervention - "[Name of patient] and daughter will be encouraged to meet via telephone and at least 1x [time] in person, with help from SW [social worker] if needed." Name/discipline of responsible staff - "SW"
Intervention - "Mouth checked during med [medication] pass." Name/discipline of responsible staff - "Nursing"

3. Active sample patient A3, MTP dated 3/8/11

Intervention - "Administer anti-depressants per physician's order and monitor side effects and effectiveness on daily tasks." Name/discipline of responsible staff - "Nursing"
Intervention - "SW will accompany to mental health court for meds over objection." Name/discipline of responsible staff - "SW"

4. Active sample patient A4, MTP dated 3/24/11

Intervention - "Nursing will redirect [name of patient] to focus on positive plan for discharge 3x week [week] 5 min [minutes] [sic]. Name/discipline of responsible staff - "RN [registered nurse], CNA [certified nursing assistant]"
Intervention - "SW will encourage [name of patient] to express her feelings and to identify 1 - 2 ways to increase her safety if suicidal thoughts recur [sic] in process group." Name/discipline of responsible staff - "SW"

5. Active sample patient A5, MTP dated 3/18/11

Intervention - "[Name of patient] will be encouraged to learn about bipolar disorder in groups and in 1:1 [one to one] conversations with staff." Name/discipline of responsible staff - "All staff, nursing."
Intervention - "Process group daily will encourage [name of patient] by requesting a question on an interest he has." Name/discipline of responsible staff - "SW"

6. Active sample patient A8, MTP dated 3/20/11

Intervention - "Provide re-direction to [name of patient] as needed q [every] shift." Name/discipline of responsible staff - "CNAs, MHTs [mental health technicians], and nurses"
Intervention - "[Name of patient] will be given1:1 attention daily to provide comfort, conversation on her well-being and orientation." Name/discipline of responsible staff - "SW"

7. Active sample patient A11, MTP dated 2/28/11

Intervention - "Q [every] 15 min checks for safety. Medication education weekly [with] [name of patient] by RN staff." Name/discipline of responsible staff - "All staff, RN staff"
Intervention - "SW will encourage [name of patient] to express himself and how to cope with stress in daily process group." Name/discipline of responsible staff - "SW"

8. Active sample patient A14, MTP dated 3/11/11

Intervention - "SW will provide emotional support to [name of patient] and encourage her to verbalize her thoughts & [and] feelings in process group daily and in 1:1 conversations." Name/discipline of responsible staff - "SW"
Intervention - "Staff to interact on 1:1 basis [with] [name of patient] and encourage with talk about loss of spouse during waking hours." Name/discipline of responsible staff - "Nursing"

9. Active sample patient A15, MTP dated 3/3/11

Intervention - "SW will engage [name of patient] in 1:1 conversations, provide encouragement to attend process groups at least once/week." Name/discipline of responsible staff - "SW"
Intervention - "Staff will prepare [name of patient] for ADL's [activities of daily living] [with] gentle reminder and orientation." Name/discipline of responsible staff - "CNA, RN"

B. Interviews

1. In an interview on 3/28/11 at 2:30p.m. with RN #1, the use of abbreviations for the nursing discipline instead of specific names of nursing staff persons on the sample patients' Master Treatment Plans was discussed. RN#1 stated, "I guess it's because it could be any nurse who does the intervention."

2. In an interview on 3/28/11 at 3:20p.m. with the Nursing Director, the lack of identifying the specific names of nurses responsible for nursing interventions on the sample patients' treatment plans was discussed. The Nursing Director stated, "We were told by a State consultant that we didn't have to do that since there are so many nurses."