HospitalInspections.org

Based on medical record reviews, review of policy and procedure and interviews, the hospital failed to conduct multidisciplinary treatment team meetings for patients on the Geropsychiatric Unit within 72 hours of admission and weekly thereafter. As a result of this deficient practice, there was no documented sharing of information to benefit the patient's progress and/or make needed revisions in care by the multidisciplinary team. This affected nine of ten sampled patients: Patient Identifier (PI) # 2, PI # 3, PI # 4, PI # 5, PI # 6, PI # 7, PI # 8, PI # 9 and PI # 10 and has the potential to affect all patients treated on the Unit.

Findings include:

Medical Record Review and Interviews:

1). Patient Identifier (PI) # 2 was admitted to the Geropsychiatric Unit on 07/19/2017 with diagnoses to include Vascular Dementia with behavioral disturbances and Major Neurocognitive Disorder with multiple etiologies.

A review of PI # 2's Multidisciplinary Treatment Plan revealed the plan was initiated on 07/20/2017. No updates were documented and the patient remains hospitalized. The psychiatrist is the only staff member who signed the plan.

During an interview on 08/09/2017 at 11:30 AM, Employee Identifier (EI) # 1, the Geropsychiatric Program Director, confirmed PI # 2's plan was not updated and was only signed by the attending psychiatrist. There were no signatures representing the other members of the multidisciplinary team to include the Social Worker, Nurse Practitioner, Activity Therapist, Physical Therapist, Dietician or Program Director.


2). Patient Identifier (PI) # 3 was admitted to the Geropsychiatric Unit on 07/1/2017 with diagnoses to include Major Neurocognitive Disorder due to multiple etiologies and Depression.

A review of PI # 3's Multidisciplinary Treatment Plan revealed the plan was initiated on 07/03/2017. No updates were documented and PI # 3 remains hospitalized indicating four team reviews were not completed / documented. The plan was signed by the attending psychiatrist and the social worker. There were no signatures representing the other members of the multidisciplinary team to include the Nurse Practitioner, Activity Therapist, Physical Therapist, Dietician or Program Director.

During an interview on 08/09/2017 at 11:35 AM, Employee Identifier (EI) # 1, the Geropsychiatric Program Director, confirmed PI # 3's plan was not updated every seven days as required by hospital policy. The plan was only signed by the attending psychiatrist and the social worker. There were no signatures representing the other members of the multidisciplinary team.


3). PI # 4 was admitted to the Geropsychiatric Unit on 07/27/2017 with a diagnosis of Moderate to advanced Dementia.

A review of PI # 4's Multidisciplinary Treatment Plan revealed the plan was initiated on 07/31/2017. PI # 3 remains hospitalized, but no updates were documented every seven days as required by hospital policy. The plan was not signed by any team member(s).

During an interview on 08/09/2017 at 11:50 AM, Employee Identifier (EI) # 1, the Geropsychiatric Program Director, confirmed PI # 4's plan was not signed or updated.


4. PI # 5 was admitted to the Geropsychiatric Unit on 07/25/2017 with a diagnosis of Major Neurocognitive Disorder due to multiple etiologies with behavioral disturbances.

A review of PI # 5's Multidisciplinary Treatment Plan revealed the plan was initiated on 07/26/2017, but was not updated even though PI # 5 remains hospitalized. PI # 5's plan was signed by the attending psychiatrist and the social worker. There were no additional signatures representing the other members of the multidisciplinary team to include the Nurse Practitioner, Activity Therapist, Physical Therapist, Dietician or Program Director.

During an interview on 08/09/2017 at 12:05 PM, Employee Identifier (EI) # 1, the Geropsychiatric Program Director, confirmed PI # 5's plan was not updated and the signatures of the multidisciplinary team to include the Nurse Practitioner, Activity Therapist, Physical Therapist, Dietician or Program Director were not documented.


5. PI # 6 was admitted to the Geropsychiatric Unit on 08/03/2017 with diagnoses to include Rule out Major Depressive Disorder, Rule out low grade delirium and Multiple Significant Chronic Medical Problems.

A review of PI # 6's Multidisciplinary Treatment Plan revealed the plan was initiated on 08/04/2017. The plan was not signed by any of the multidisciplinary team members.

During an interview on 08/09/17 at 12:13 PM, Employee Identifier (EI) # 1, the Geropsychiatric Program Director, confirmed PI # 6's plan was not signed by staff.


6. PI # 7 was admitted to the Geropsychiatric Unit on 07/25/2017 to include diagnoses of Vascular Dementia with behavioral disturbances and Depression due to known physical conditions.

A review of PI # 7's Multidisciplinary Treatment Plan revealed the plan was initiated on 07/31/2017 (six days after admission). According to the policy, a written plan must be formulated within 72 hours of admission. The attending psychiatrist was the only signature on the plan. The plan was not signed by any of the multidisciplinary team members to include the Social Worker, Nurse Practitioner, Activity Therapist, Physical Therapist, Dietician and Program Director.

During an interview on 08/09/2017 at 12:20 PM, Employee Identifier (EI) # 1, the Geropsychiatric Program Director, confirmed PI # 6's was not initiated until 07/31/2017 and plan was not signed by staff.


7. PI # 8 was admitted to the Geropsychiatric Unit on 07/21/2017 with diagnoses to include Major Neurocognitive Disorder due to multiple etiologies with behavioral disturbances and Organic Psychosis.

A review of PI # 8's Multidisciplinary Treatment Plan revealed the plan was initiated
on 07/25/17. No updates were documented even though PI # 8 remains hospitalized. According to hospital policy, revision will occur not less than every seven days during the hospital course. The only team member who signed the plan was the attending psychiatrist

During an interview on 08/09/2017 at 1:15 PM, Employee Identifier (EI) # 1, the Geropsychiatric Program Director, confirmed PI # 8's plan was not revised and the psychiatrist was the only team member who signed the plan.


8. PI # 9 was admitted to the Geropsychiatric Unit on 08/03/2017 with a diagnosis of Schizoaffective Disorder.

A review of PI # 9's Multidisciplinary Treatment Plan revealed the plan was developed on 08/03/2017, but no staff signatures were documented on the plan.

During an interview on 08/09/2017 at 1:37 PM, Employee Identifier (EI) # 1, the Geropsychiatric Program Director, confirmed PI # 9's plan was not signed by any members of the multidisciplinary team.

9. PI # 10 was admitted to the Geropsychiatric Unit on 08/02/2017 with diagnoses to include Major Neurocognitive Disorder due to multiple etiologies with behavioral disturbances and Depression.

A review of PI # 10's Multidisciplinary Treatment Plan revealed the plan was developed on 08/04/2017. PI # 10's plan was signed by the attending psychiatrist and the social worker, but there were no signatures representing other members of the multidisciplinary team to include the Nurse Practitioner, Activity Therapist, Physical Therapist, Dietician or Program Director.

During an interview on 08/09/2017 at 1:57 PM, Employee Identifier (EI) # 1, the Geropsychiatric Program Director, confirmed PI # 10's plan was not signed by the Nurse Practitioner, Activity Therapist, Physical Therapist, Dietician or Program Director, all members of the multidisciplinary team.


II. Policy and Procedure Review:

A. Multidisciplinary Treatment Plan:

Revision Date: 12/2016

Statement of Purpose: To organize data, identify needs, "not systematically plan the course of treatment." The plan will reflect a "focuses" approach and serve as the central reference of interventions, expectations, goals and objectives for treatment rendered. This policy will act to delineate the process involved in the development and documentation of the treatment course.

Policy: It is the policy of the Psychiatric Program to formulate a written, individual Treatment Plan based on a comprehensive assessment of the patient's needs within 72 hours of each admission.

Procedures:
1. Responsibility for the development and implementation of the Treatment Plan is ultimately assigned to the attending psychiatrist, the program director, psychiatric nurse practitioner(s), and or graduate level social worker(s)...

4. Multidisciplinary involvement will be established commencing with plan formulation and maintained throughout implementation and final evaluation. This involvement will be documented and accountability clearly defined...

7. The Treatment Plan includes:

- A working DSM-5 diagnosis (DSM-5: the standard classification of mental disorders used by mental health professionals in the U.S., wwwdsm5.org)

- Identification of problem(s)

- Behavioral manifestations of the problem(s)

- Patient strengths used in the plan

- Short and long term goals with target dates.

- Documentation: Patient medical record.

- May be performed by: Attending Psychiatrist, Program Director, Psychiatric Nurse Practitioner(s), Graduate Level Social Worker.


B. Policy: Multidisciplinary Treatment Plan Review:

Revision Date: 12/2016

Statement of Purpose: To provide a multidisciplinary method for revising, changing or continuing a plan of care according to the patient's progress and response to treatment rendered.

Policy: It is the policy of the Psychiatric Program to review and evaluate each patient's treatment plan...

Procedures:

1. Treatment Plan reviews will be documented and implemented as clinically indicated, but will occur not less than every seven days during the hospital course.

2. The entire treatment team will be present for the review(s) and attendance will be documented...

4. Each treatment plan review must be signed by the attending Psychiatrist and/or Program Director.

5. Documentation of the review is the responsibility of the attending Psychiatrist or his/her designee.

6. All disciplines will have input into the review process...

Documentation: Patient medical record.

May be performed by: Attending Psychiatrist, Program Director, Psychiatric Nurse Practitioner(s), Nursing Staff, Social Worker(s), Activity Director, Physical Therapist, Dietician, Discharge Planner.