HospitalInspections.org

Based on record review, review of policy and staff interview it was determined the hospital failed to ensure the patient's right to participate in the development and implementation of his or her plan of care for eight (8) of eight (8) patients reviewed who had treatment plans initiated (patients #1, 2, 3, 4, 7, 8, 9 and 10). This failure creates the potential for the rights of all patients to be violated.

Findings include:

1. Review of the medical record for patient #1, age 14, revealed no documentation to reflect the patient's legal representative was afforded the opportunity to participate in the development and implementation of the 9/12/11 treatment plan.

2. Review of the medical record for patient #2, age 13, revealed no documentation to reflect the patient's legal representative was afforded the opportunity to participate in the development and implementation of the 10/4/11 treatment plan.

3. Review of the medical record for patient #3, age 10, revealed no documentation to reflect the patient's legal representative was afforded the opportunity to participate in the development and implementation of the 10/4/11 treatment plan.

4. Review of the medical record for patient #4, age 11, revealed no documentation to reflect the patient's legal representative was afforded the opportunity to participate in the development and implementation of the 9/26/11 treatment plan.

5. Review of the medical record for patient #7, age 15, revealed no documentation to reflect the patient's legal representative was afforded the opportunity to participate in the development and implementation of the 9/22/11 treatment plan.

6. Review of the medical record for patient #8, age 16, revealed no documentation to reflect the patient's legal representative was afforded the opportunity to participate in the development and implementation of the 9/26/11 treatment plan.

7. Review of the medical record for patient #9, age 16, revealed no documentation to reflect the patient's legal representative was afforded the opportunity to participate in the development and implementation of the 10/3/11 treatment plan.

8. Review of the medical record for patient #10, age 14, revealed no documentation to reflect the patient's legal representative was afforded the opportunity to participate in the development and implementation of the 10/4/11 treatment plan.

9. The policy "Treatment Planning", effective January 2010, was provided for review. The policy states in part: "The multidisciplinary treatment plan is developed at the treatment plan staffing conference...The individualized treatment plan is reviewed with the parent, legal guardian or custodial parent and are requested to sign."

10. During the afternoon of 10/5/11, the treatment plan process was discussed with the Director of Clinical Therapies. She acknowledged the current treatment plan process does not include the patient's legal representative. She confirmed that currently the legal representative is not afforded the opportunity to attend the treatment plan conference.

Based on review of staff training records and staff interview it was determined the hospital failed to ensure staff have education, training and demonstrated knowledge of the use of nonphysical intervention skills. This failed practice involved sixteen (16) of of forty-nine (49) staff reviewed who were working on the Adolescent Unit (S 1 through S 16). This failure creates a potential for staff to overreact to patient behaviors and could result in the implementation of more restrictive interventions than are necessary to deescalate behaviors.

Findings include:

1. The training records for staff who are working the Adolescent Unit were reviewed. A review of the Nonphysical Intervention skills training dates revealed it had been greater than one (1) year since the training was provided for sixteen (16) of the forty-nine (49) staff reviewed (S 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 and 16.)

2. The following policy "Restraint & Seclusion", effective date September 2008, was provided for review. The policy stated in part: "Initial training occurs during orientation ...and ongoing education/training is provided on a yearly basis. Staff education and ongoing training includes: ...The use of non-physical intervention skills."

3. The staff training records and policy were discussed with the Nurse Manager of the Behavioral Health Unit in the morning of 10/6/11. She acknowledged the nonphysical interventions skills training for these staff was not current. She indicated the staff were being scheduled for the training.