River Oaks Failed to Assess and Document Patients' Problems, Progress, and Responses to Treatment

River Oaks Hospital in Harahan, Louisiana, was cited during an unannounced complaint inspection completed by the Centers for Medicare and Medicaid Services (CMS) for deficiencies related to patient rights, RN supervision of nursing care, treatment plans, recording progress, discharge planning, and medical staff bylaws. CMS found that River Oaks failed to ensure the patient’s problems/need, interventions, progress, and responses to treatment were assessed and documented. In one example, a patient was placed in seclusion twice in two days for jumping on tables, running, throwing toys at staff, attempting to scratch and bite staff, kicking, and head-butting. A review of the Master Treatment Plan revealed no documented evidence the patient’s plan was updated to include these behaviors, updated rationale for continued need for seclusion, or evidence of the incident in the form of an incident report. In another example, a 9 year old boy wrapped a shirt around his neck and said “I want to kill myself.” The inspection found that an assessment and communication to the psychiatrist about the incident never took place and an incident report was never filed. In another case, a patient physically punched another child on the head over a movie. The patient was isolated from the rest of the facility and given Vistaril, a sedative. Upon further examination of the hospital documents, the inspector did not find an inspection report or an assessment of the patient’s behaviors. CMS also found that the facility did not reassess the effectiveness of administered medications on patient behaviors. Also, River Oaks failed to include patient incidents in the patient master treatment plan and the facility’s master incident log. The inspection found that the facility failed to ensure short-term and long range goals including specific dates for achievement. Also, the facility failed to ensure that written treatment plans included specific treatment interventions and the responsibilities of each staff member for each intervention. CMS found deficiencies related to Patient rights: care in a safe setting in four areas of the facility. CMS found:
  • Chemicals in an unlocked and unsupervised room in the children’s/adolescent unit
  • A broken hard plastic lid to a linen cart with jagged, hard, pointed sharp edges to be accessible to patients in the day room
  • Window frames and jams with flaking and peeling paint.
  • Air conditional vents with paper and rags stuffed into the vent by patients preventing air flow.
The inspection also found deficiencies related to medical staff bylaws and discharge planning. The findings in the report stated that the Physician Delinquency Rate for completing medical records within 30 days for January 2012 was 39% and the delinquency rate for the year 2011 was 42%. Despite the high rate of physician delinquency rate, the Medical Director of the hospital indicated in the report “there were no disciplinary actions or suspension of privileges related to delinquent records, because he did not see the need for it.” In the plan of correction, the facility agreed to review the policy and procedures related to reporting and tracking adverse patient events.  The facility also agreed to review the current treatment planning process and train nursing staff on the procedures for treatment planning.