HospitalInspections.org

Based on document review and interview, the nursing staff failed to follow the hospital policy and notify a patient's (P1) power of attorney or authorized family member after a reported fall, for 1 of 10 patient's medical records reviewed.

Findings Include:

1. Facility policy "Fall Prevention Program", PolicyStat: 13554604, last approved 04/2023, indicated that a fall notification will be made to provider, administration, and family immediately upon discovery of a fall event.

2. Medical record review indicated P1 had an unobserrved fall on 01/04/2024. The medical record, lacked documentation that staff had notified P1's power of attorney, or authorized family member of the reported fall on 01/04/2024.

3. The facility incident reporting log lacked documentation that staff had notified P1's power of attorney, or authorized family member of P1's reported fall on 01/04/2024.

4. At 1542 hours on 03/13/2024, per interview with S2, Quality/Risk, confirmed that P1's medical record and incident reporting log did not indicate any documentation that the patient's power of attorney (POA) or authorized family members were notified of P1's fall in accordance with facility policy.