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Based on interview and record review, the hospital failed to investigate, protect the patient, or report to the Department, when one alleged incident of abuse was reported to staff. This has the potential that patients are not free from abuse during hospitalization.

Findings:

During a concurrent interview and review of the clinical record for Patient 57 with the Manager of Clinical Documentation and Care Improvement (MCDCI), the form, Multidisciplinary Daily Activity, dated 3/27/16, at 4:40 AM, indicated: "Patient newly admitted, lives with spouse... Patient stated that when they were in ER (emergency room) her husband slap her on her face." The MCDCI reviewed the clinical record and stated Patient 57 was 66 years old, admitted to the hospital 3/27/16 at 2:30 AM and discharged home 3/28/16 at 2 PM. The Discharge Planner documented on 3/28/16, at 11:25 AM: "Plan for home with spouse. No needs at this time." The MCDCI stated she could not find any documentation of this abuse allegation anywhere else in the chart. She stated, "The nurse who documented this incident (Registered Nurse [RN] 18) did not document she reported it to anyone---another nurse, the police, the physician or social services." The MCDCI was asked what her expectation of staff actions were when they were informed or made aware of verbal abuse. The MCDCI stated, "1. [Staff] needs to de-escalate the situation, call Security if they need to. (Security writes up a report.) 2. Separate 3. Interview patient." The MCDCI was asked what the staff actions should be if they saw or are made aware of physical abuse. The MCDCI stated, "The first three I just described. In addition, 4. Report---Social Services, police. 5. Follow abuse policy 6. Inform patient of report unless further harm could result." The MCDCI called Social Services and was informed there was no report of this incident. The MCDCI called the hospital's security office and was informed there had been no notification from the ED (emergency department) or anyone else of any alleged abuse incident on 3/26/16 or 3/27/16. The ED Triage and Assessment Record dated 3/26/16, timed 9:20 PM, was reviewed. It described Patient 57 as "agitated", "alert and oriented", "lives with spouse", with the primary reason for coming to the ED as "head neck pressure throbbing to ears". Under the heading of "Additional Notes", at 9:20 PM, 3/26/16, it was documented: "Upset yelling @ spouse. Spouse left ER (Emergency Room). No evidence of domestic violence other than verbal abuse towards husband."

During an interview with RN 18 on 3/29/16, at 5:15 PM, she stated she remembered Patient 57 and the alleged abuse incident. RN 18 stated she did not notify anyone other than the day shift charge nurse (RN 19) at the end of her shift. RN 18 stated, "I'm not sure if it's true or not. When I admitted her, she was confused and distraught. If the allegation is true, the investigation should have started in the ED. I received faxed information from the ED that did not inform me of any abuse occurring there. There was no verbal report from another nurse. I did not read the whole chart. Not even after she told me she got slapped."

During an interview with RN 19 on 3/29/16, at 5:30 PM, she stated she remembered Patient 57 and the alleged incident. RN 19 stated, "I spoke with Patient 57 and she said her husband got real frustrated with her---she wanted him to get the nurse---and he hit her in the face. There was no bruises noted. I called the day supervisor, RN 20. [RN 20] called me back and said as long as there was no bruises, we didn't need to report it."

During an interview with RN 20 on 3/29/16, at 5:38 PM, she stated, "[RN 19] told me about the husband who slapped (Patient 57) in the face while in the ER. I looked up the policy. I told [RN 19] to be sure to make a referral to Social Services."

During a second interview with RN 19 on 3/29/16, at 5:48 PM, she stated, "[RN 20] did tell me to make a referral to Social Services and I didn't do it."

The hospital policy and procedure titled "Assault and Abuse Reporting Requirements", dated 7/14/04, indicated: "Hospitals and other health care providers are required by law to report assault and abuse. Abuse of an elder....includes physical abuse....Elders are persons 65 years of age or older..."

The hospital policy and procedure titled "Mandated Reporting Requirements", dated 1/26/06, indicated: "Facility personnel and medical staff are responsible for identification of events that may require mandated reporting. It is the responsibility of the individual who identified the event or the department manager's, or division chief to report to the proper authorities.... (Circumstance) Assault Victims Domestic Violence (report by whom) Emergency Dept, Social Services Dept, Nursing Staff (report to whom) Local Law Enforcement (When/How) Phone police immediately and written report--two (2) working days. Forms in ED: Nursing Units...."

Based on observation, interview, and record review, the hospital failed to maintain a safe and effective environment when:

1. An unsecured oxygen cylinder was found in a patient bathroom.
2. The emergency decontamination shower did not have a shower head.

These failures had the potential for an unsafe or ineffective emergency response for patients, staff or visitors.

Findings:

1. During an observation and interview with the registered nurse Manager of Clinical Documentation and Care Improvement (MCDCI) on 3/28/16, at 3:25 PM, an unsecured oxygen tank was noted to be in the bathroom of vacant Room 201. The MCDCI agreed that it should not be unsecured and immediately removed it from the room.

2. During an observation and interview with the Nurse Manager of the Emergency Department (NMED) on 3/29/16, at 9:30 AM, the decontamination shower was noted to be without a shower head. The faucet was turned on and the thin stream of water produced by the long, hand held tubing had a high velocity to it without the shower head in place. The NMED agreed that it could not be used on the face, stating, "A staff member would have to assist if a patient needed to have a shower."

The hospital policy and procedure titled "Bioterrorism Readiness Guidelines", dated 1/25/12, indicated: "....E Post Exposure Management....The goal of decontamination after a potential exposure... is to reduce the extent of external contamination of the patient... After removal of contaminated clothing, immediately shower with soap and water, to include the shampooing of hair..."