Table 7


Identified Text of InterestState Psychiatric Hospitals, Georgia (12/08/09)Ancora Psychiatric Hospital, Winslow, NJ (8/24/09)Kings County Hospital, NY (1/30/09)NW Georgia Regional Hospital-Rome (1/5/09)George Regional Hospital-Atlanta (5/30/08)Oregon State Hospital (1/9/08)
Ensure that, before nursing staff work directly with patients, they have completed successfully competency-based training regarding mental health diagnoses, related symptoms, psychotropic medications, identification of side effects of psychotropic medications, monitoring of symptoms and target variables, and documenting and reporting of the patient's status.As shown, page 47, E.4.n/aEssentially the same I, page 53, D.4.As shown, page 62, D.4.As shown, page 59, D.4.Essentially the same I, page 44, D.2.
Ensure that nursing staff accurately and routinely monitor, document, and report patients' symptoms and target variables in a manner that enables treatment teams to assess the patient's status and to modify, as appropriate, the treatment plan.As shown, page 47, E.5.Similar Concept, page 35, C.7.Essentially the same I, page 53, D.5.As shown, pages 62 & 63, D.5.As shown, page 59, D.5.Essentially the same I, page 44, D.3.
Ensure that nursing staff actively participate in the treatment team process and provide feedback on patients' responses, or lack thereof, to medication and behavioral interventions.As shown, page 47, E.6.n/aAs shown, page 53, D.6.As shown, page 63, D.6.As shown, page 59, D.6.As shown, page 44, D.4.
Ensure that each patient's treatment plan identifies:
  1. the diagnoses, treatments, and interventions that nursing and other staff are to implement;

  2. the related symptoms and target variables to be monitored by nursing and other unit staff; and

  3. the frequency by which staff need to monitor such symptoms

As shown, page 48, E.10.n/aAs shown, page 53, D.7.As shown, page 63, D.10.As shown, page 59, D.10.As shown, page 45, D.8.
Ensure sufficient nursing staff to provide nursing care and services in accordance with generally accepted professional standards.As shown, page 47, E.3.n/an/aAs shown, page 62, D.3.As shown, page 58, D.3.As shown, page 44, D.1.
Ensure that nursing staff are appropriately supervised to ensure that they administer, monitor, and record the administration of medications and any errors according to generally accepted professional standards.As shown, page 47, E.7.Similar Concept, page 35, C.3.n/aAs shown, page 63, D.7.As shown, page 59, D.7.Similar Concept, page 44, D.5.
Ensure that, prior to assuming their duties and on a regular basis thereafter, all staff responsible for the administration of medication have completed successfully competency-based training on the completion of the Medication Administration Record.As shown, page 47, E.8.n/an/aAs shown, page 63, D.8.As shown, page 59, D.8.As shown, page 44, D.6.
Ensure that all failures to properly sign the Medication Administration Record and/or the Narcotics Log are treated as medication errors, and that appropriate follow-up occurs to prevent reoccurrence of such errors.As shown, page 47, E.9.n/an/aAs shown, page 63, D.9.As shown, page 59, D.9.Essentially the same, page 44, D.7.
  • * Text of interest in the Nursing Section was observed in only 6 of the 15 Findings Letters.