Ochsner Medical Center-Kenner

“PATIENT RIGHTS: NOTICE OF RIGHTS CFR(s): 482.13(a) Patients’ Rights: Notice of Rights This Standard is not met as evidenced by: 50453 Based on record review and interview the hospital failed to ensure that the medical record contained documented evidence of patient notification of their rights. This deficient practice was evidenced by failing to have the patient/patient representative sign the statement of Patient Acknowledgment of Rights for 2 (#2, #3) of 3 (#1-#3) patients reviewed. Findings: A review of the hospital policy titled, “Patient Rights and Responsibilities,” effective date: 11/13/2023, revealed in part: “III. Policy Statement B. Each patient/representative shall be informed of the Patient Rights and Responsibilities ... IV. Policy Implementation A. Patient Rights C. Admission and Hospitalization 1. During the admit process, patients/representatives shall be provided with a copy of the Patient Rights and Responsibilities.” Review of Patient #2 and Patient #3’s medical records failed to reveal documentation that Patient #2 or Patient #3 were informed of their Patient Rights. In an interview on 12/10/2024 at 8:59 a.m. S1DQ confirmed that there was no documentation in the medical records that Patient #2 or Patient #3 were notified of their Patient Rights.”

“ADMINISTRATION OF DRUGS CFR(s): 482.23(c)(1), (c)(1)(i) & (c)(2) (1) Drugs and biologicals must be prepared and administered in accordance with Federal and State laws, the orders of the practitioner or practitioners responsible for the patient’s care as specified under §482.12(c), and accepted standards of practice. (i) Drugs and biologicals may be prepared and administered on the orders of other practitioners not specified under §482.12(c) only if such practitioners are acting in accordance with State law, including scope of practice laws, hospital policies, and medical staff bylaws, rules, and regulations. (2) All drugs and biologicals must be administered by, or under supervision of, nursing or other personnel in accordance with Federal and State laws and regulations, including applicable licensing requirements, and in accordance with the approved medical staff policies and procedures. This Standard is not met as evidenced by: 50453 Based on record review and interview, nursing staff failed to administer PRN medications in accordance with accepted standards of practice. This deficiency is evidenced by failure of the nursing staff to monitor the therapeutic effect of PRN medications in 1 (#2) of 3 (#1-#3) patients reviewed. Findings: Review of hospital policy titled, “Assessment and Reassessment (Hospitalized Patients),” effective date: 12/13/2021, revealed in part: “IV. Procedure C. The patient’s plan of care, treatment, and services will be based on needs identified by the patient’s assessment, reassessment, response to interventions and results of diagnostic testing. G. Patients will be reassessed at the following times: 6. Response to intervention.” Patient #2 Review of Patient #2’s medication administration record revealed the following PRN medications were administered: 11/21/2024 at 5:12 p.m. - Chlorpromazine, 25mg Intramuscular every 6 hours, PRN for Severe Agitation. 11/22/2024 at 12:02 a.m. - Melatonin, 6mg oral tablet, one tablet nightly, PRN for Insomnia. 11/22/2024 at 1:37 a.m. - Chlorpromazine, 25mg Intramuscular every 6 hours, PRN for Severe Agitation. 11/22/2024 at 3:09 a.m. - Lorazepam, 1mg IV Injection, every 6 hours, PRN for Anxiety/Agitation. 11/22/2024 at 4:05 p.m. - Haloperidol, 5mg IV Injection, every 6 hours, PRN for Agitation. 11/30/2024 at 9:28 a.m. - Haloperidol, 5mg IV Injection, every 6 hours, PRN for Agitation. Further review of Patient #2’s medical record and medication administration record failed to reveal a re-evaluation of the effectiveness of the medications listed above. In an interview on 12/09/2024 at 1:47 p.m., S5TUM confirmed the above mentioned findings and verified that there was no documented re-evaluation of effectiveness. S5TUM also confirmed that all PRN medications and interventions should be re-evaluated by the nurse.”

“PATIENT RIGHTS: NOTICE OF RIGHTS CFR(s): 482.13(a)(1) A hospital must inform each patient, or when appropriate, the patient’s representative (as allowed under State law), of the patient’s rights, in advance of furnishing or discontinuing patient care whenever possible. This Standard is not met as evidenced by: 50453 Based on record review and interview, the hospital failed to ensure each patient was informed of patient rights. This deficient practice was evidenced by failure to inform Patient #1 of their patient rights in a language or manner non-English speaking patients could understand. Findings: Review of hospital policy titled “Patient Rights and Responsibilities,” effective date: 11/13/2023, revealed in part: III. Policy Statement B. Each patient/representative shall be informed of the Patient Rights and Responsibilities ... IV. Policy Implementation A. Patient Rights 1. Non-Discrimination. Every patient has the right to be provided services in a non-discriminatory manner. This Organization prohibits discrimination based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression in accordance with applicable federal and state laws and regulations. 4. Dignified, Respectful Care. Every patient has the right to receive care in an environment that preserves dignity, respects each patient’s psychosocial, spiritual, and cultural values and beliefs, and contributes to a positive self-image. Further, every patient has the right to be cared for by providers and staff educated about patient rights and their own individual roles in supporting these rights. 5. Informed Care. Every patient has the right to be informed, in understandable terms and in a manner tailored to the patient’s age, language, and ability to understand, of his or her health status, treatment, prognosis, plan of care, discharge, and follow-up in order to make decisions as to care. Every patient has the right to know the nature, risks and alternatives to treatment. The patient has the right to be informed, when appropriate, regarding the outcome of the care provided, including unanticipated outcomes. 20. Interpretation. The patient has the right to be provided with interpretation services if he or she does not speak English ... and to have any other resources employed on his or her behalf to ensure effective communication. C. Admission and Hospitalization 1. During the admit process, patients/representatives shall be provided with a copy of the Patient Rights and Responsibilities. Review of Patient #1’s medical record revealed that the patient was Spanish speaking. Further review of Patient #1’s medical record failed to reveal that the patient was informed of their patient rights. During an interview on 10/02/2024 at 3:00 p.m., S4PIS and S5RN confirmed that there is no documented evidence that the patient was notified of their patient rights.”

“RN SUPERVISION OF NURSING CARE CFR(s): 482.23(b)(3) A registered nurse must supervise and evaluate the nursing care for each patient. This Standard is not met as evidenced by: 50453 Based on record review and interview the hospital failed to ensure the Registered Nurse evaluated the care of each patient in accordance with accepted standards of nursing practice. This deficiency is evidenced by: 1) failure to document that an interpreter/translator was used to complete the Nursing Assessments and Provider Assessment, for non-English speaking Patient #1; 2) failure to document a reassessment on 2 (#1, #3) of 4 (#1-#4) patients as per policy. Findings: 1) Failure to document that an interpreter/translator was used to complete the Nursing Assessments and Provider Assessment, for non-English speaking Patient #1. Review of hospital policy titled, “Interpreter Services for Limited English Proficiency Patients,” Effective Date 01/14/2021, revealed in part: V. Policy Implementation B. Interpreter Services are free of charge and available to patients 24/7 upon patient request of staff identification of the need for an interpreter. F. The choice of the patient with respect to accepting or declining interpreter services, the presence of an interpreter and the means through which the interpreter is provided (In-person, VRI or OPI) will be documented in the electronic medical record at each visit. Review of Patient #1’s medical record revealed documentation that the patient “Needs Interpreter: Spanish.” Documentation also revealed that Language Interpreter accepted by patient. Further medical record review failed to reveal documentation that an interpreter/translator service was used to communicate with the patient by the nurse or provider. During an interview on 10/02/2024, S5RN confirmed that there was no documentation that the nurse used an interpreter service for communication with Patient #1 who was Spanish speaking. During an interview on 10/03/2024, S6EDRD confirmed that there was no documentation that the ED provider used an interpreter service for communication with Patient #1 who was Spanish speaking. 2) Failure to document a reassessment on 2 (#1, #3) of 4 (#1-#4) patients as per policy. Review of hospital policy titled, “Emergency Department Assessment Standards,” Approval Date: 1027/2023, revealed in part: C. Reassessment: 1. The frequency of the reassessment is based on the patient’s acuity, condition, history and complaint, or as directed by the physician; minimally every 4 hours. Review of hospital policy titled, “Assessment and Reassessment (Hospitalized Patients),” Effective Date: 12/13/2021, revealed in part: IV. Procedure G ... Patients will be reassessed at the following times: 2. Upon transfer, admit or discharge from another unit as set forth in this operational standard. 7. Within two hours of discharge. Review of Patient #1’s medical record revealed that Patient #1 arrived on 08/19/2024 at 4:49 a.m. by ambulance with complaints of Suicide. Patient #1 was triaged and a nursing assessment was documented on 08/19/2024 at 5:00 a.m. Patient #1 was transferred from the ED to another facility on 08/19/2024 at 1:20 p.m. Further review of Patient #1’s medical record failed to reveal a reassessment documented on the Patient #1 by a nurse as per policy. During an interview on 10/03/2024 at 11:17 a.m., S7EDS confirmed there is not a documented reassessment on the patient since initial assessment prior to departure. Review of Patient #3’s medical record revealed that Patient #3 arrived on 09/26/2024 at 1:33 p.m. with a complaint of Flu symptoms. Patient #3 was triaged and a nursing assessment was documented on 09/26/2024 at 2:22 p.m. Patient #3 was transferred from ED to another facility on 09/27/2024 at 12:15 a.m. Further review of Patient #3’s medical record failed to reveal a reassessment documented on the Patient #3 by a nurse as per policy. During an interview on 10/03/2024 at 10:17 a.m., S6EDRD and S7EDS confirmed there is not a documented reassessment on the patient since initial assessment prior to departure.”

“PATIENT RIGHTS: FREE FROM ABUSE/HARASSMENT CFR(s): 482.13(c)(3) The patient has the right to be free from all forms of abuse or harassment. This Standard is not met as evidenced by: 44495 Based on record review and interview, the facility failed to ensure all patients were free from abuse. The deficient practice is evidenced by the security officer striking a patient in the face in 1 (#3) of 2 (#3, #4) reviewed records where a patient was confronted by a security officer. Findings: Review of Operational Standard # OHS.SEC.032, “Code White,” issued June 2017, revealed in part, “I. Purpose: This operational standard outlines the process for responding to a security alert or combative person in a manner which considers the safety, security and welfare of patients, visitors, and staff. .. .IV. Procedure: . . .F. Security officers shall utilize non-violent crisis intervention techniques. Staff members in high risk areas, such as security, Emergency Department or psychiatric units shall receive training in non-violent crisis intervention.” Review of Policy # OHS.PTREL.001, “Patient Rights and Responsibilities,” effective 11/13/2023, revealed in part, “IV.A.2. - Safe Environment. Every patient has the right to receive care in a safe setting and the right to personal safety (free from mental, physical, sexual, and verbal abuse, or humiliation, neglect, and exploitation).” Review of the medical record for Patient #3 revealed admission on 08/30/2024. Patient #3 had a history of asthma and was noted to have difficulty breathing while under a Corner’s Emergency Certificate at a psychiatric facility. Patient #3 was transferred to the acute care hospital for treatment and was admitted with a diagnosis of hypoxia and schizophrenia. Review of the orders for Patient #3 revealed the patient was on one to one observation with a sitter. Review of the incident self- reported to the licensing authority revealed on 08/31/2024 at 9:06 p.m., Patient #3 broke free from his soft restraints and a Code White was called. Patient #3 exited the room, fell, and then tried to enter several patient rooms before entering the restroom in an empty patient room and closing the door. When security opened the door, Patient #3 hit S8SO with a closed fist under the right eye and S8SO delivered defensive counterstrike, contacting the patient’s left eye.” In interview on 09/09/2024 at 2:25 p.m., S5SM verified S8SO hit the patient in the face and S8SO received no disciplinary action. S5SM stated, “The security officer was attacked and they have a right to defend themselves as long as they do not become the aggressor.””

“PATIENT RIGHTS: RESTRAINT OR SECLUSION CFR(s): 482.13(e)(4)(ii) [The use of restraint or seclusion must be--] (ii) implemented in accordance with safe and appropriate restraint and seclusion techniques as determined by hospital policy in accordance with State law. This Standard is not met as evidenced by: 44495 Based on record review and interview, the facility failed to insure the use of appropriate restraint and seclusion techniques. The deficient practice is evidenced by failure of the hospital to provide documentation a maneuver used by security was a therapeutic hold or met the standard of care for restraint of a spitting patient. Findings: Review of Operational Standard # OHS.SEC.032, “Code White,” issued June 2017, revealed in part, “I. Purpose: This operational standard outlines the process for responding to a security alert or combative person in a manner which considers the safety, security and welfare of patients, visitors, and staff. .. .IV. Procedure: . . .F. Security officers shall utilize non-violent crisis intervention techniques. Staff members in high risk areas, such as security, Emergency Department or psychiatric units shall receive training in non-violent crisis intervention.” Review of Policy # OHS.PTREL.001, “Patient Rights and Responsibilities,” effective 11/13/2023, revealed in part, “IV.A.2. - Safe Environment. Every patient has the right to receive care in a safe setting and the right to personal safety (free from mental, physical, sexual, and verbal abuse, or humiliation, neglect, and exploitation).” Review of the Safety on Site (SOS) Occurrence Report for the incident on 08/05/2024 revealed in part, “Patient had spit at security guard and then S7SO (security guard) forcefully pushed head away from him and pushed it into the pillow. He went to clean spit off after this and then came back to room with female security guard and appeared to bring his hand down quickly toward the patients face. Patient then began to cry and curled her knees into her body. She had been screaming and her demeanor changed at that moment. I was able to back up and see a more clear view and S7SO’s hand was then around the patient’s lower jaw, chin, and appeared to be resting firmly on her chest. The female officer said something to him in response to his actions. She had a clear view of the situation and may be able to add to the details of this. The patient continued to repeat the same thing that S7SO had pushed her head into the pillow and then knocked her teeth in. I tried to check her mouth but she wouldn’t allow me to.” Review of the security report 08/05/2024 at 1:51 a.m. revealed in part, “ On Monday August 5, 2024, at approximately 1:51 a.m., Dispatch contacted security in reference to a patient in room “A” screaming for the police. The call for assistance was from 4B nursing staff. I, S7SO, along with S9SO arrived on the scene at 1:52 a.m. to hear PEC patient yelling for the police, stating that there were people in her house. Security informs her she in fact is in the hospital and does not believe security. Security attempts multiple times to calm the patient down, to no avail. At this time security is made aware that the patient has been diagnosed as bipolar. At approximately 2:10 a.m., the patient begins to calm down until the patient begins to kick at staff, nearly striking them on the leg. Security restrained the patient and at that time the patient spat at myself, with saliva coming in contact with my uniform shirt and beard. Security quickly gained control of the patient while medication was administered. As security was attempting to clear the scene, the patient again began kicking at the air and attempting to swing the TV remote at nursing staff. No one was contacted during the incident as security once again restrained the patient as the nursing staff now were placing 2 point soft restraints on the patient’s wrists, as prescribed by the attending physician. At this time, the patient attempted to spit at security again, but the patient’s face was gently guided away, prevented any fluids from being projected. In interview on 09/09/2024 at 12:30 p.m., S3CRM verified that she had investigated the incident and there were only three people in the room at that time, the nurse and the two security officers. S3CRM verified that the three staff members were interviewed. The nurse who submitted the report had concerns, but stated that the female security officer had a better view than she did. Both the female security officer and male security officer verified the hold on the jaw was properly applied and there was no excessive use of force. S3CRM verified her report of the investigation concluded that proper Crisis Prevention and Intervention (CPI) techniques were used. On 09/10/2024 at 9:15 a.m., the surveyor requested documentation that the maneuver used to forcefully hold the patient’s jaw down to the chest was part of the education provided and standard of care for a spitting patient. S2DQ and S3CRM verified they were not sure if the hold was covered in CPI training. On 09/10/2024 at 11:25 a.m. S2DQ verified that S5SM had replied to the request for documentation and verified that the maneuver was not part of the formal education and he had no documentation that it was an accepted method or standard of care. S5SM stated the maneuver was part of the hands on training for a biting patient. S2DQ verified the report indicated Patient #4 was spitting at staff not biting.”

“PATIENT RIGHTS: RESTRAINT OR SECLUSION CFR(s): 482.13(e)(5) §§482.13(e)(5) - The use of restraint or seclusion must be in accordance with the order of a physician or other licensed practitioner who is responsible for the care of the patient and authorized to order restraint or seclusion by hospital policy in accordance with State law. This Standard is not met as evidenced by: 44495 Based on record review and interview, the facility failed to ensure restraints were performed on the order of a physician. The deficient practice is evidenced by the documented use of restraints without a physician’s order in 1 (#4) of 2 (#3, #4) reviewed medical records where restraints were used. Findings: Review of Policy # OHS.QUAL.009, “Restraint and Seclusion Use,” effective 09/15/2022, revealed in part: IV. Policy Statement A.Ochsner recognizes that patients have the right to be free from physical or mental abuse and corporal punishment. . . . . B.3. A physician order must be obtained for the use of restraints or seclusion. . . . V. A. . . . Physical holds, specifically the application of force to physically hold a patient, in order to administer a medication against the patient’s wishes is considered restraint. Review of the security report 08/05/2024 at 1:51 a.m. revealed in part, “ On Monday August 5, 2024, at approximately 1:51 a.m., Dispatch contacted security in reference to a patient in room “A” screaming for the police. The call for assistance was from 4B nursing staff. I, S7SO, along with S9SO arrived on the scene at 1:52 a.m. to hear PEC patient yelling for the police, stating that there were people in her house. Security informs her she in fact is in the hospital and does not believe security. Security attempts multiple times to calm the patient down, to no avail. At this time security is made aware that the patient has been diagnosed as bipolar. At approximately 2:10 a.m., the patient begins to calm down until the patient begins to kick at staff, nearly striking them on the leg. Security restrained the patient and at that time the patient spat at myself, with saliva coming in contact with my uniform shirt and beard. Security quickly gained control of the patient while medication was administered. As security was attempting to clear the scene, the patient again began kicking at the air and attempting to swing the TV remote at nursing staff. No one was contacted during the incident as security once again restrained the patient as the nursing staff now were placing 2 point soft restraints on the patient’s wrists, as prescribed by the attending physician. At this time, the patient attempted to spit at security again, but the patient’s face was gently guided away, prevented any fluids from being projected. Security cleared the scene at 2:15 a.m. with no further incident. No one was contacted or injured during the incident, and I did not wish to press charges due to the patient’s mental state. At approximately 5:30 a.m., security was called to stand by as nursing staff placed soft restraints on the patient’s legs. Security cleared the scene at 5:48 a.m. with no further incident.” Review of the orders for Patient #4 revealed the first orders for restraints on 08/05/2024 were placed at 4:41 a.m., initiated at 4:42 a.m., and discontinued at 5:36 a.m. In interview on 09/10/2024 at 10:42 a.m., S3CRM verified there was no order for the physical hold performed by security and no order for restraints initiated on 08/05/2024 between 2:00 a.m. and 2:15 a.m.”