1 850 Riverview Avenue Pineville, Kentucky PINEVILLE COMMUNITY HOSPITAL Patient/Resident Abuse, Neglect, and Misappropriation of Property Prevention Program Date: 8/99 Revised Date: 11/30/99 Revised Date: 2/2002 Revised Date: 12/2002 Revised Date: 10/2010
2 PINEVILLE COMMUNITY HOSPITAL 850 Riverview Avenue Pineville, Kentucky Phone PATIENT/RESIDENT ABUSE AND NEGLECT PREVENTION PROGRAM PURPOSE To guide in the demonstration of patient/resident abuse and neglect protection. POLICY Patients/Residents will not be subjected to mental, sexual, or physical abuse or neglect by anyone, including staff, other patients/residents, visitors, or family members. DEFINITIONS Abuse The willful inflection of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish; includes deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well being. Mental Abuse Includes, but is not limited to, humiliation, harassment, and threats of punishment or deprivation. Physical Abuse Includes hitting, slapping, pinching, or kicking. Also includes controlling behavior through corporal punishment. Sexual Abuse Includes, but is not limited to, sexual harassment, sexual coercion, and sexual assault. Verbal Abuse The use of oral, written, or gestured language that willfully includes disparaging and derogating terms to residents or their families, or within ther hearing distance, regardless of their age, ability to comprehend, or disability. Neglect Occurs when an individual does not receive care in one or more areas (e.g., absence of frequent monitoring for a patient/resident by placing them in seclusion). Misappropriation of Patient/Resident Property the deliberate misplacement; exploitation; or wrongful, temporary, or permanent use of a patient/resident s belongings or money without his/her consent. Abused or Neglected Child A child whose health or welfare is harmed or threatened with harm when the parent, guardian, or other person who has permanent or temporary care, custody or responsibility for the supervision of the child, inflicts or allows to be inflicted upon the child physical or mental injury, acts of sexual abuse, abandonment, exploitation, or lack of adequate care and supervision, by not appropriately providing food, clothing, shelter, education, or medical care necessary for the childs well being. Battered Child Syndrome A child or infant who has suffered repeated injuries often including fractures and neurological damage, at the hands of parents or surrogates. Battered Spouse Victim of battering physical behavior, emotional abuse, and sometimes sexual abuse which most often happens repeatedly over a long period of time and usually escalates. Domestic Abuse Abuse behaviors that reflect domestic struggles for power and control; abuse may be physical, sexual, psychological, emotional or economic. Involuntary Seclusion Separation of a resident from other residents or form her/his room or confinement to her/his room (with or without roommates) against the resident s will, or the will of the resident s legal representative. Page 1 of 8
3 Patient/Resident Abuse, Neglect, Misappropriation of Property page 2 of 8 Procedures A. Hiring Practices Criminal background and reference checks will be conducted on employees. This includes requesting information from previous and/or current employers, and checking with the appropriate licensing boards and registries. B. Patient/Resident/Family Education 1.) Patients/Residents and families will be informed of abuse policies and procedures on admission and periodically thereafter. 2.) Patient/Residents and families will be given an educational handout on abuse and neglect. (See addendum A) C. Training Employees shall be trained during orientation and annually thereafter on patient/resident abuse and neglect, including: 1.) Appropriate interventions to deal with aggressive patients/residents. 2.) How to report allegations of abuse/neglect of adults and children. 3.) How to report allegations of domestic violence/battered spouse syndrome. 4.) How to recognize signs of burnout, frustration, and stress that may lead to abuse. 5.) What constitutes abuse, neglect, and misappropriation of property. D. Prevention 1.) Patient/Residents, families and staff should be encouraged to report concerns, incidents, and grievances without fear of retributions. 2.) Feedback will be provided regarding all concerns. E. Identification Any event suspicious of patient/resident abuse should be reported immediately to the supervisor or charge nurse. Examples include bruising, physical assault, wrongful withholding of food and an ignored yelling patient/resident. F. Investigation 1.) The supervisor or charge nurse shall notify the department director immediately who shall notify the administrator. In the absence of the Department Director, the Supervisor or Charge Nurse shall notify the Risk Manager. 2.) The supervisor will assess the patient/resident and notify the physician. 3.) The supervisor (and employee if applicable) shall complete an incident report for each complaint. 4.) All information concerning the incident such as names of persons who may have knowledge or input will be documented. 5.) An internal investigation will be conducted. After completion, the patient/resident, his/her family or guardian will be notified of findings. 6.) Interviews shall be conducted with the person(s) making the complaint, the person allegedly abused, and the person(s) allegedly abusing, All interviews shall be documented. 7.) The investigations shall be aggregated and analyzed as to type of complaint, cause, shift, personnel, etc. 8.) The internal investigation should be completed within 5 working days and the administrator informed of the findings.
4 Patient/Resident Abuse Neglect Misappropriation of Property page 3 of 8 9.) During the investigation the accused employee may be suspended or reassigned until the investigation is complete. 10.) In the event that the Supervisor/Charge Nurse cannot reach the Department Manager or the Risk Manager, the Supervisor/Charge Nurse will be responsible for notifying the State Survey Agency. G. Protection The supervisor will look at each individual concern and determine what, if any, actions need to be taken to protect the patient/resident from further harm. H. Misappropriation of Patient/Resident Property 1.) The supervisor or designee shall investigate any report of a loss or theft of a patients/resident s personal property. The supervisor is also responsible for getting back to the patient/resident, his/her family, or staff with a response to any allegation. 2.) The supervisor (investigator) shall talk to the patient/resident, any roommate, family members, and staff members who were on duty at the time of the misappropriation of property. 3.) The supervisor shall record and maintain records of loss/theft reports as well as investigation findings. 4.) Abuse/Neglect educational programs shall include information regarding the importance of personal property to the patient/resident 5.) Family members should be encouraged to report the loss of personal property immediately to the nurse caring for the resident. 6.) An investigation will begin immediately upon receiving a complaint. 7.) All employees should keep a watchful eye for items out of place. Items out of place should be brought back to the patient s/resident s room before it gets lost. 8.) Patients/Residents should be assisted in using and storing their belongings properly. Lock boxes are available in each room. 10.)Staff members should not: - protect a thief - ignore careless practice - borrow a patients/residents property - accept gifts from patients/residents or family members without supervisor approval 11.)Patients/Residents and family should be encouraged to: - mark patients/residents items clearly - make sure an inventory listing of patient/resident belongings is complete and kept current. - use proper storage containers - report any problem immediately
5 Patient/Resident Abuse Neglect Misappropriation of Property page 4 of 8 I. Reporting/Response for Abuse/Neglect/Misappropriation of Property 1.) All alleged/suspected violations of patient/resident abuse/neglect, including injuries of unknown source, and misappropriation of resident property will be reported immediately to the appropriate local/state/federal agencies including the State Survey and Certification Agency, and the Department of Community Based Services, Adult Protective Services via telephone or fax. 2.) A report will be made to the state nurse aide registry or licensing authorities of any knowledge of actions by a court of law that would indicate an employee is unfit for service. 3.) Any occurrence will be analyzed to determine what changes, if any are needed to prevent further occurrences. 4.) Appropriate corrective action will be taken for verified violations. 5.) The results of all investigations of alleged/suspected abuse/neglect, or misappropriation of property will be aggregated and analyzed and a written report will be forwarded to the Administrator and to the State Survey and Certification Agency within 5 working days of the incident. 6.) The hospitals Social Services Department will be notified of all cases of suspected adult, child abuse and domestic violence. Social Services will notify the appropriate agencies to arrange for investigation, referral and follow up as needed. 7.) After hours and on weekends, the Department for Public Health Division of Social Services will be notified directly by the Charge Nurse/Supervisor to initiate prompt investigation, referral and follow up as needed. An on call schedule is posted in each Nursing Unit. Date: 8/99 Revised Date: 11/30/99 Revised Date: 2/2002 Revised Date: 12/2002 Revised Date: 10/2010
6 SIGNS OF POSSIBLE CHILD ABUSE, NEGLECT, OR EXPLOITATION Physical Abuse Unusually frequent accidental injuries requiring visits to the Emergency Department Unexplained bruises Injuries such as fractures, lacerations, burns Inconsistencies between injuries sustained and history of injuries as related by parent/surrogate. Psychological Abuse A manner that reflects fear, intimidation, or withdrawal Aggressive, hostile, destructive or cruel behavior Excessive anxiety Evidence of lack of bonding with parents and siblings Extremely passive, apologetic Neglect Underweight/malnourished/dehydrated Poor hygiene, unkempt, body and hair dirty, odorous Inappropriately and/or inadequately dressed Inadequate medical/dental care Seeks attention/affection from strangers Exploitation Mismanagement of resources by parent/surrogate Sexually exploited Characteristics of Abusive Parents/Surrogates Parents who have low self esteem Parents who have a low tolerance level for frustration Parents with negative/unrealistic attitudes toward children Parents who are socially isolated and have no time away from children Parents who express fear of harming the child Parents in crises and under undue stress Characteristics of Victims of Spouse Abuse/Domestic Violence Battered spouse has low self esteem Abusive spouse suffers from guilt Severe stress reaction by abused and/or abuser Battered spouse uses sex as a way to establish intimacy with abuser Abuser exhibits extremes of jealousy Abuser uses sex as an act of aggression to enhance self esteem Abuser displays feeling of inadequacy and failure and is unable to express feelings
7 SIGNS OF POSSIBLE ADULT ABUSE, NEGLECT, OR EXPLOITATION PHYSICAL ABUSE Injuries such as fractures, laceration, burns Unexplained bruises Physical evidence not consistent with medical history Sexual assault by family member or caretaker Victims of domestic violence may also exhibit choke marks, injuries about the abdomen, breasts, or torso area PSYCHOLOGICAL ABUSE Afraid of caretaker, spouse, or other individual Extremely passive, apologetic Demeaning language, tone of voice, disrespect exhibited by caretaker Isolated from contact with others CARETAKER NEGLECT Poor hygiene, unkempt, body and hair dirty, odorous Inappropriately and/or inadequately dressed Hungry, malnourished, dehydrated Medications improperly administered Not taken for needed medical services SELF NEGLECT Poor hygiene, unkempt, body and hair dirty, odorous Inappropriately and/or inadequately dressed Hungry, malnourished, dehydrated Confused, disoriented, does not take medicines as instructed Unable to manage own resources EXPLOITATION Mismanagement of resources by caretaker or other person Victim of fraud Sexually exploited
8 EXCERPTS FROM ADULT PROTECTION LAW. KRS (2) any person, including, but not limited to, physician, law enforcement officer, nurse, social worker, department personnel, coroner, medical examiner, alternate care facility employee, or caretaker, having reasonable cause to suspect that an adult has suffered abuse, neglect, or exploitation, shall report or cause reports to be make in accordance with the provisions of this chapter. Death of the adult does not relieve one of the responsibility for reporting the circumstances surrounding the death (3) An oral or written report shall be made immediately to the department upon knowledge of the occurrence of suspected abuse, neglect, or exploitation of an adult Anyone acting upon reasonable cause in the making of any report or investigation or participating in the filing of a petition to obtain injunctive relief or emergency protective services for an adult pursuant to this chapter, including representatives of the department in the reasonable performance of their duties in good faith, and within the scope of their authority, shall have immunity from any civil or criminal liability that might otherwise be incurred or imposed. Any such participant shall have the same immunity with respect to participation in any judicial proceeding resulting from such report or investigation and such immunity shall apply to those who render protective services in good faith pursuant either to the consent of the adult or to court order (1) Anyone knowingly and willfully violating the provisions of KRS (2) shall be guilty of a Class B misdemeanor as designated in KRS REPORTING HOTLINES Adult/Child Abuse Reporting Hotline = For anyone to report any known or suspected cases of adult/child abuse, neglect, or exploitation. Or you may contact your local Department for Social Services Office. Nursing Home Ombudsman Hotline = For anyone to report known or suspected cases of abuse, neglect, or exploitation of persons who reside in licensed health care facilities. INFORMATION AND REFERRAL YWCA Spouse Abuse Center Hotline = For anyone wanting information on domestic violence or needing referral for shelter or related services. Kentucky Crime Victims Hotline = Victims Advocacy Division Office of the Attorney General For anyone wanting general information related to crime victim services. Remember, ABUSE..it hurst at any age!
9 Patient/Resident Abuse Tracking Form Name Room Number Date of Occurrence Injuries Sustained Appropriate Notification of All Agencies Immediate Action taken To Prevent Recurrence Substantiated * Attach a copy of all Patient/Resident Abuse Reports and Findings of Investigations
10 Patient/Resident Misappropriation of Property Tracking Form Name Room Number Date of Occurrence Date of Response Item(s) reported missing Appropriate Notification of All Agencies Immediate Action taken To Prevent Recurrence Substantiated Personal Property Recovered * Attach a copy of all Reports and Findings of Investigations Develop Date: 10/5/10
11 850 Riverview Avenue Pineville, Kentucky Patient/Resident Abuse Reporting and Investigation Form Name of Patient/Resident Room No. Age: [ ] Male [ ] Female Location of Incident: Date Incident Occurred: Time: Date Incident Reported: Time: Incident Reported By: [ ] Patient/Resident [ ]Employee [ ] Family Member [ ] Visitor [ ] Other Name of Individuals Reporting Incident: Type of Abuse: [ ] Verbal [ ] Physical [ ] Sexual [ ] Neglect [ ] Other: Injuries Sustained: [ ] Yes (describe injuries) [ ] No Injuries required medical attention: [ ] Yes (describe [i.e., hospital, sutures, physician services, etc.]) [ ] No Was the injury caused by a medical device? [ ] Yes (describe) [ ] No Name(s) of witness(es) to the incident: Name of person(s) accused: Is the accused individual(s) an [ ] Employee [ ] Family Member [ ] Visitor [ ] Patient/Resident [ ] Other: Describe the circumstances surrounding the incident (use additional paper if needed): What immediate action(s) were taken to protect the patient/resident? (use additional paper if needed) What immediate steps were taken to prevent the incident from recurring? (use additional paper if needed) Notifications: Date Time By Whom Department Director/Risk Manager Administrator Department for Community Based Services Division of Protection and Permanency State Survey Agency fax # Attending/On Call Physician Signature/Title of individual completing this form: Date: Signature of Department Director: Date Reviewed:
12 Investigation Findings Did the medical record review indicate any previous or unexplained injuries? [ ]Yes (describe use additional paper if needed)[ ]No Summary of interview with person(s) reporting the incident (use additional paper as necessary): Summary of interview with witness(es) (use additional paper as necessary): Summary of interview with patient/resident (use additional paper as necessary): Summary of interview with staff members having contact with the patient/resident during the period of the incident ( use additional paper as necessary): Summary of interview with patient s/resident s roommate (as applicable) (use additional paper as necessary): Summary of interview with patient s/resident s family members/visitors (use additional paper as necessary): Summary of investigator s findings (use additional paper as necessary): Did the findings indicate that abuse occurred? [ ] Yes [ ] No (if NO please explain) Corrective action taken (use additional paper as necessary): Did the patient/resident and/or the representative (sponsor) participate in determining the appropriate corrective action that was taken? [ ] Yes [ ] No (If NO, please explain why they did not participate.) Results of findings and corrective action taken reported to: [ ] Patient/Resident Representative Date: Time: By Whom: [ ] Risk Manager Date: Time: By Whom: [ ] State Survey Agency Date: Time: By Whom: [ ] Attending Physician Date: Time: By Whom: [ ] Nurse Aide Registry Date: Time: By Whom: [ ] Administrator Date: Time: By Whom: [ ] Date: Time: By Whom: [ ] Date: Time: By Whom: Additional Comments (use additional paper as necessary): *Attach supporting documents to this report Date: Signature/Title Investigating Representative Date: Signature of Department Director Date: Signature Administrator