Nursing Investigation Results -

Pennsylvania Department of Health
ST. CLAIR HOSPITAL
Patient Care Inspection Results

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ST. CLAIR HOSPITAL
Inspection Results For:

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ST. CLAIR HOSPITAL - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:
This report is the result of a Department of Human Services, Chapter 5100 Mental Health Procedures Act Survey conducted on February 21, 2020 at St. Clair Hospital. It was determined the facility was not in compliance with requirements of the Chapter 5100 Mental Health regulations.



 Plan of Correction:


5100.15 (2) REQUIREMENT Treatment Plan Content and Availability:State only Deficiency.
5100.15 CONTENTS OF TREATMENT PLANS

(a) A comprehensive individualized plan of treatment shall:
(2) Be based upon diagnostic evaluation which includes examination of the medical, psychological, social, cultural, behavioral, familial, educational, vocational, and developmental aspects of the patients situation.
Observations:

Based on review of facility documentation, medical records (MR), and staff interviews (EMP), it was determined the facility failed to ensure a comprehensive individualized plan of treatment was based upon medical and psychological aspects of the patients situation for two of two medical records reviewed (MR7 and MR8).

Findings include:

Review of facility policy and procedure "Treatment Planing" approved February 2020, revealed "A. The Master Treatment Plan integrates information gathered from a comprehensive multidisciplinary assessment and focuses on the patient's symptoms/behaviors that precipitated hospitalization."
Review of facility policy and procedure "Administration of Psychotropic Medication against a Patient's Will" revised November 2018, revealed "5. Medication objections should be documented in the individualized treatmetn plan. Treatment team planning and review sessions should afford the patient (and those helping the patient) with the opportunity to discuss their concerns or protests about any aspect of the proposed treatment plan."
1. Review of MR7 on February 21, 2020, revealed a physician order on November 27, 2019, for administration of medication against the patients will. Further review of the Treatment Plan revealed no documentation or discussion of forced medication.
Interview with EMP1 on February 21, 2020 at 1:00 PM confirmed the above findings and revealed "I don't see it [discussion of forced medication].
2. Review of MR8 on February 21, 2020, revealed a physician order on November 7, 2019, for administration of medication against the patients will. Further review of the Treatment Plan revealed no documentation or discussion of forced medication.

Interview with EMP1 on February 21, 2020, at 1:20 PM confirmed the above findings and revealed "There's nothing there they [treatment team] talked about forced meds."












 Plan of Correction - To be completed: 05/01/2020

In order to improve compliance with documenting Medication Over Objection (forced medications) into the patient's individualized treatment plan, the following multifaceted approaches were taken.

Information Technology (IT) Enhancements:

- On March 5th 2020 a Customer Service Request (CSR) was submitted to the Information Technology (IT) department. The CSR request includes the development of a Nursing Instruction Order for "Medication over Objection (Forced Medications)" that would be entered electronically by the physician. The order would include the medications approved to be administered, as well as, a reminder for staff to document Medication Over Objection in the patient's individualized treatment plan. The service request will be completed on or prior to April 3rd 2020.

Education:

- The Director of Psychiatry & Mental Health in collaboration with the department's Clinical Educator developed a unit specific educational huddle. The huddle focuses on reviewing the content within the "Administration of Psychotropic Medication Against a Patient's Will" policy. Specific emphasis was placed on the importance of documenting Medication Over Objection into the patient's individualized treatment plan. This huddle will be reviewed with all Registered Nurses within the Psychiatric Department during the week of March 9th 2020.
- Psychiatrists will be educated on the new "Medication over Objection (Forced Medications)" electronic order entry once completed by the IT Department. Education will be in the form of verbal communication and written communication conducted by the Chief of Psychiatry & Mental Health.
- Psychiatric Department Registered Nurses will receive further education about the new "Medication Over Objection (Forced Medications)" electronic physician to nurse order entry during their scheduled departmental staff meeting on April 8th 2020.

Compliance Monitoring:

- An audit of psychiatric inpatient medical records that received Medication over Objection (Forced Medications) will be conducted on a monthly basis.
- The audit will verify the entry of Medication over Objection (Forced Medications) into the patient's individualized treatment plan.
- The denominator will equal the number of medical records reviewed and the numerator will equal the number of medical records compliant with Medication over Objection (Forced Medications) entered into the patient's treatment plan.
- Results of the audit will be shared at the monthly Patient Safety Committee meeting and the Psychiatry & Mental Health Clinical Leadership Group. It will remain a standing item on both agendas until a minimum of 90% compliance is achieved for 4 consecutive months.
- All monitoring results will be provided to the Quality Safety & Service Committee of the Board until completion.




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