Go to the State of Colorado Web
Occurrence Summary Reports for:
COLORADO MENTAL HEALTH INSTITUTE AT PUEBLO-PSYCH
Thursday, November 23, 2017 4:12 AM

Facility: COLORADO MENTAL HEALTH INSTITUTE AT PUEBLO-PSYCH
Date of Occurrence: 6/5/2015
Report Timely: Yes
Type of Occurrence: Neglect

DESCRIPTION OF OCCURRENCE:
On 06/05/15 a male patient, in his 80s, was allegedly intentionally left soiled by a staff member.

FACILITY ACTION:
The facility conducted an internal investigation. The facility notified the physician, police department and appropriate facility administration and personnel. Staff member (A), who was assigned as the patient's one to one staff, noted that the patient needed to be changed. Staff member (A) informed the nurse and the nurse replied to wait until the next shift came on duty. Staff member (A) stated she proceeded to change the patient once she had been relieved of her one to one assignment. Staff member (A) reported the patient's Depends was dried to the skin and difficult to remove. The nurse was placed on administrative leave pending an investigation. The patient was assessed and there were no signs of impaired skin integrity noted. Staff interviews revealed staff member (B) had assisted staff member (A) in cleaning the patient and denied the feces were dried or difficult to remove. Staff member (C) reported the nurse was attending to another patient with an urgent situation. The facility determined the nurse postponed patient care after they were informed the patient was soiled. The nurse resigned in lieu of termination.

DEPARTMENT FINDINGS:
The Department reviewed the facility's report and supplemental documentation and found that the facility acted appropriately by reporting the occurrence, notifying the appropriate persons and agencies, suspending the alleged nurse, assessing the patient, conducting an investigation, and removing the nurse from employment at the facility.

The Department will review this occurrence prior to any survey or upon receipt of any complaint that may be filed against this facility.


Sent to Facility: 7/10/2015

FACILITY COMMENT: Following receipt of the above summary, no additional comments were submitted by the facility.


Released to Public: 7/24/2015

Back to List of Occurrences for:COLORADO MENTAL HEALTH INSTITUTE AT PUEBLO-PSYCH