HospitalInspections.org

Based on a review of records, policy and procedure, quality data, correspondence and interviews it was determined that the facility failed to provide an environment where the patient's right to dignity and comfort was respected.

Findings were:

Review the facility's unnumbered policy, "Patient Rights and Responsibilities, no revision date, revealed: The hospital respects the rights of the patient, recognizes that each patient is an individual with unique health care needs, and because of the importance of respecting each patient's personal dignity, provides considerate, respectful care focused care for the patient's needs; the patient has a right to care in a safe setting; the patient has the right to be free from all forms of abuse or harassment.

Review of the medical record of Patient #2 revealed that the patient was admitted to the facility in June of 2017. Patient #2 had diagnoses of acute respiratory failure, lung disease, hypertension, calorie malnutrition, type II diabetes, acute renal failure and wounds in the perineal area and buttocks. According to the record, Patient #2 had weakness throughout his/her body and initially required physical and occupational therapy.

A physical therapist documented that Patient #2 had impaired physical mobility and required one-on-one therapeutic activities to improve the patient's ability to function. The record revealed that Patient #2 also required continued supervision with bathing, Foley (urinary catheter) care, linen changes, mouth and skin care.

The physician documented on 6/15/17 that while at the bedside in the intensive care/high observation unit, he/she spoke to Patient #2's sibling, who was not happy with some of the nursing issues. The physician's note indicated that the issues were being addressed.

An RN's notes on 6/15/17 at 6:46 p.m. revealed that Patient #2's assessments and hygiene care which included a bath, mouth care, oral suctioning, linen changes and Foley care had been done with the help of two staff. Nurses also documented that Patient #2 was repositioned and propped on pillows every two hours to relieve pressure.

A nurse documented that hygiene care had been provided to Patient #2 again on 6/16/17 at 4:35 a.m., which included the same type of care services as the previous day.
A second hygiene care was documented at 3:33 p.m. on 6/16/17. However, the record revealed that Patient #2's hygiene care had not been documented again until 10:49 a.m. on 6/17/17.

On 6/19/17 the physical therapist documented that he/she had a long discussion with Patient #2 and his/her sibling who was visiting from another state about Patient #2's physical therapy, plan of care, respiratory status, and treatment. The physical therapist documented that the family's questions and concerns were answered regarding Patient #2's current needs.

During a telephone interview at 11:45 a.m. on 8/3/17, in the conference room, Physician #12 stated that Patient #2 had a rectal tube which could have contributed to a smell in the room. Physician #12 explained that he/she did not witness the patient lying in feces or urine and that he/she had spoken to a supervisor who was involved in addressing the concerns. Physician #12 stated that when he/she arrived in the room, the patient had been cleaned up.

In an interview at 10:45 a.m. on 8/3/17 in the education room, RN #2 stated that he/she was the nurse for Patient #2 who had a tracheostomy, a urinary catheter, and rectal tube. RN #2 stated that there was one incident when the rectal tube leaked and nursing staff cleaned Patient #2.

During an interview with the day shift supervisor (RN #13) at 11:40 a.m. on 8/3/17 in the conference room he/she stated that he/she was called to Patient #2's room and met the patient's sibling who was visiting from out of town and had some concerns about Patient #2's care. RN #13 stated that he/she noticed that Patient #2 had already been cleaned up when he/she arrived. When asked by the surveyor if he/she had received complaints from patients about staff being rude, disrespectful or displaying mistreatment, RN #13 stated that since taking the position as supervisor he/she had not received any complaints from patients that staff were rude or disrespectful.

During an interview at 1:00 p.m. on 8/2/17 in the education room, the director of quality acknowledged that the facility had received multiple patient and family complaints between 1/2017 and 6/2017 regarding issues with staff's delays in responding to call lights. He/she stated that complaints from patients relatives regarding patient's delayed baths and lack of hygiene care had also been an issue.
The director of quality submitted the facility's quality data for May, June, and July which revealed that the Performance Improvement Team had had discussions about call lights.
The documentation indicated that the facility was tracking and monitoring call light responses. The facility's conclusion of the tracking indicated that the facility had reached an 80% call light response time in June.

The director of quality stated that the facility continued to have issues with call light responses and that in the past staffing was increased but the results of increased staffing did not show that there were improvements in call light response time.

Review of staffing for the High Observation/ICU unit from 6/13/17 to 6/19/17, revealed that staffing was adequate and within the guidelines of the facility's staff requirements.

Review of personnel files # (1, 2, 3, 4, 5 and 6) for staff that had provided care for patient #2 revealed that all contained initial applications and job descriptions; all had the required orientation; had current competency testing and evaluations.