Death of Patient Effective date:*

The review of the incident report log disclosed several instances of pharmaceutical mishaps. Some examples are: Wrong medications were sent home with the patient • Inventory disclosed missing or expired medications • Unauthorized person was granted access to the pharmacy room • Medication administered at the wrong time • Medication transcribed with the wrong dispensing frequency • Medication ordered but not transcribed or dispensed • Doctor transcribed medication to the wrong patient chart • ETS/ITF Arlington Campus

ETS/ITF Arlington Campus is inadequate: The average patient load of 36-42 patients per day at ETS exceeds • the 20 patients per day capacity the facility was designed to serve Fire safety requires external doors to remain unlocked allowing • patients held involuntarily the opportunity to leave the facility There are not enough interview rooms for the current patient load • Nurses' stations are cramped • Medical equipment is antiquated • Computer systems are several generations behind current • standards The lack of wireless communication within the facility requires • manual charting No connectivity to RCRMC main campus servers prevents the consolidation of patient records compounding the opportunity for charting errors The quagmire of EDA and the Office of Statewide Hospital Planning and Development (OSHPD) policies hinder any efforts to repair the facility. ETS/ITF Policies and Procedure No. 15.1 – Death of Patient

Policy No.15.1 describes procedures to be followed upon the death of a patient. The policy as written is not clear. Section 1 of Policy No. 15.1 prioritizes internal staff notification without suggesting that "911" be called to assess the patient. Section 1-c indicates a call to the Coroner/Public Administration be made "when appropriate," while Section 1-d indicates that the Coroner must always be notified. Section 2 requires staff to call for an ambulance to transport the patient to an emergency room for pronouncing of death, but Section 1-d indicates that the Coroner's office will pick up the body. Section 3 requires a call to OneLegacy, an organ transplant facilitator, without regard to patient or family desires (see Attachment #1). Policy No. 12.1 Levels of Observation This policy is dated "3/12." The policy is incomplete, consisting of pages 4. "1 of 5," "3 of 5" and "5 of 5" (see Attachment #2). Policy No. 20.1

"1 of 5," "3 of 5" and "5 of 5" (see Attachment #2). Policy No. 20.1

There are two policies numbered No. 20.1 One is dated "3/12" and titled "Therapeutic Groups (Process)" superseding Policy No. N8.03. This policy contains page "1 of 2," but is missing. The second policy has a revision date of "6/7/2013" and titled "EMERGENCY TREATMENT SERVICES (ETS) / INPATIENT TREATMENT FACILITY (ITF) DISCHARGE PROCEDURE" superseding Policy No. N12.05 (see Attachments #3 and #4).

At time of Discharge, complete the followmg: a. When other disciplines have completed their port1ons of the Aftercare Instructions, the Registered r'-lurse will sit with the patient and revievv and complete Aftercare lnstru::;tions with the patient ensuring confidentiality. b. Ask the patient if she/he wouio like a designated person (e.g., family member, tnend, significant other. etc.l to join the Reg1stered Nurse and the patient, to hear the discharge mstructions Nursing staff will sit with the patient in the day room to discuss the aftercare instructions with the patient (and family/significant other if present) while maintair1ing patient confidentiality (Obtain written consent from the patient as needed. and indicate so on the form). Aftercare Instructions will also mclude follow-up appointments and may rnclude special dietary needs. c. If the pat1ent is under conservatorship, the Conservator must be notified of the pending dtscharge. Pnvate Conservator's number should be in the' chart or contact Riverside County Conservators Office at (951) 34 ·1-6440 d:. Have the ;:JEliient verbalize understandtng of instructions. and tndicate so on the form. e Review possible tood/drug tnteracttons ancl give thE: Food and Drug pamphlet to the patrent and mdicate so on the form. Encourage patient compliance with the Aftercare Instructions. g. Up:::late Treatment Plan, resolvtng patient problem(SJ wl11ch led to admission. h. F>rov1de thE: Patient with the Client Survey. and indicate so on tt1e form .A.sk the pattent if they would be willing to complete the su·vey before they leave the U'1it or they can mai: it tn. (Does not apply to ETS patio:1ts) 1-\sstst the patient Ill gathering all of his/her property hom the pattent s bedroom j, Ass1st the patient m gathering al' of hts/her property from the patient's locker. k Tile Regrstered Nurse will w~ite the dtscharge note. and ensure the time of discharge and the time on the Satety Check sheet, coincide NOTE: lnte:-prP.ter/Translatlon Servtces t'-l be .nil1zed as needed Distribuuon Dupannwnt a' :::>:;yc:llwtry Nurs/11[1 - -- . ---- ----··-- --------- --- ;SubjectEM ~ E · RGENCYTREATMENT i Policy No. 20.1 SERVICES (ETS)IINPATIENT TREATMENT I ! FACll::_ITY iiT_f)_QIS(_;Ij_~RGE PROC_;Dl)_B_; j___ _______ .. ---···--------~- ---~-------------·---___] 6 A F1rearms Pronibit1on must bt: completed and explained to the follow1ng patients if applicable a Patients admitted to ITF on 5150 tor clan3er· to self ancl/or others. I). Patrents rn 1-:·F on 5250 for danger to sel:. danger tu others. and/or grave: disability. c. Patrenb rn I'TF on Temporary Conservatorship or permanent Conservc::norship. NOTE: Patients admitted to ITF voluntanly m S150 as Gravely Drsabled 01--JL )1 do not · :·equrre a Firearms Prohioitron. Obtarn discharge medications and pauent's personal medicatrons (if patient brough: medicat1ons to the hospital with nrrn) a. Compare medicat1on bottles with the physician's discharge order. b. Confirm medrcatrons are fo: the correc: parient, correct medications, dosages, and frequency. c Confirm medication intormatior sheets are included fron, pharmacy. and that mformat1on sheets are for the correct medication.