HospitalInspections.org

Based on staff interview and review of medical records and hospital policies, it was determined the hospital failed to ensure nursing staff developed and kept current a nursing care plan for 1 of 10 medical/surgical patients (#2) whose records were reviewed for nursing POC. This resulted in a lack of direction to nursing staff caring for patients and had the potential to interfere with patient care. Findings include:

A policy, "Transdisiplinary Care Planning" revision date July 2005, directed the staff to initiate the POC within 24 hours of admission. The Transdisiplinary Care Team will then meet within 72 hours of admission to further develop the plan. At least every two weeks thereafter, the Transdisiplinary Team will meet to revise and update the established care plan and to discuss discharge options and needs.

Patient #2 was a 78 year old male admitted to the facility on 10/12/10 for rehabilitation and medical care related to peritonitis and wound care. A progress note dictated 10/19/10, indicated Patient #2 had probable Parkinson disease, and a baseline mental status exam was discussed with the family.

Patient #2's progress notes on 11/24/10 stated he had "Nightingale Syndrome." (According to Segen's Medical Dictionary. ? 2011 "A term of questionable usefulness defined as either a situation in which a romantic attraction or bond develops between patient and caregiver and is the direct result of the care giving experience.") The progress note documented Patient #2 had become quite attached to one of the nursing assistants, and had offered the CNA financial aid, when it was not accepted, he had difficulty coming to terms with it. Progress note entries by the attending physician document Patient #2's attachment with the particular CNA as follows:
11/20/10 "Pt remains disgruntled re: CNA not being allowed to care for him. Pt has become quite fond of her and apparently made offer to pay for Nursing School. The CNA has become slightly uncomfortable with this bond he has developed."

11/21/11 " Pt reports he is sad at not being able to provide for CNA. He wants her to care for him and for him to provide for her in a non-adulterous, nonsexual, financial manner."

11/22/10 "Pt continues with perseveration of Florence Nightingale Syndrome with continued insistence to have specific CNA care for him and to have her after he discharges to home." The progress note continues with "I feel part of his perseveration may be tied with dementia."

11/24/10 "Patient stated "I feel bad this morning, I'm very depressed. Don't want to do anything. Don't care if I go or if I stay. They won't let me see the staff that I want to see."

11/25/10 "Pt perseverating that [his] CNA doesn't have enough money for clothes as she is wearing big sweaters and overcoat at night in the hospital to keep warm."

11/26/10 "Patient still anxious about CNA, stated I want to send her kids to camp, and I want to find her a good husband."

11/27/10 "Patient continues to worry about CNA."

11/30/10 "Pt. still depressed today due to CNA not here today and [his] not talking to her."

12/03/10 "Still perseverating thoughts on CNA."

On 10/19/10 at 5:45 PM, an order was written for a neuropsych evaluation and baseline mental status evaluation. The order was noted by an RN on 10/19/10 at 7:00 PM.

A neuropsych evaluation was not found in Patient #2's record. In an interview on 5/12/11 at 4:00 PM, the Director of Case Management reviewed the record and was unable to find documentation that an evaluation had been made.

A form titled "TRANSDISIPLINARY PLAN OF CARE," dated 10/12/10, was an 8 page pre-printed Plan of Care that allowed for 6 weeks of documentation and updates. "Problem 4, PSYCHOLOGICAL ADJUSTMENT" was not initiated or updated, the entire section remained blank.

During an interview on 5/12/11 at 4:00 PM, the Director of Case Management reviewed the record and confirmed there were no nursing interventions documented regarding Patient #2's mental status. She stated the concern had been addressed with Case Management and that department was aware of Patient #2's psychosocial needs.

The facility did not address the patient's psychosocial needs in the Plan of Care.