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Based on medical record review, staff interview, and policy review, the hospital failed to ensure the use of restraints was in accordance with the orders of a physician or other licensed practitioner for two of six patients reviewed with restraints (Patient #2 and #8 ). The total sample was ten records. The active census was 339.

Findings include:

Review of the policy titled, Restraint and/or Seclusion, revised 12/2021, revealed a restraint is any manual method, physical or mechanical device, material, or equipment that immobilized or reduces the ability of a patient to move his or her arms, legs, body or head freely and that he/she cannot easily remove. Easily remove means that the manual method, device, material or equipment can be removed intentionally by the patient in the same manner as it was applied by staff.

The policy further states to obtain and initial order from the Licensed Independent Physician (LIP) who is responsible for the care of the patient prior to the application of restraint or seclusion. ( Note: A registered nurse (RN) may initiate emergency application of restraint or seclusion to ensure the safety of the patient and others. However, a LIP order is required immediately after the restraint or seclusion has been applied. The original order may only be renewed for up to a total of 24 hours/each calendar day.

1. Review of the medical record for Patient #2 revealed an admit date of 11/04/22 to the intensive care unit. The patient had a history of intravenous heroin and methamphetamine use with diagnoses to include severe sepsis, septic pulmonary emboli, and concern for endocarditis. Review of the restraint flow sheets revealed the patient was being monitored in non-violent bilateral soft wrist restraints on 11/04/22 beginning at 12:00 PM and remained actively restrained through 11/07/22. Review of the physician orders revealed no evidence of an order for non-violent bilateral wrist restraints on 11/04/22.

This finding was confirmed in an interview with Staff A on 11/07/22 at 2:25 PM.

2. Review of the medical record for Patient #8 revealed an admit date of 10/31/22 to the intensive care unit with diagnoses of diabetic ketoacidosis, influenza A, and sepsis. Review of the restraint flow sheets revealed the patient was being monitored in non-violent bilateral soft wrist restraints beginning on 11/04/22 at 12:00 AM and remained in active restraints until 11/07/22. Review of the physician orders revealed no evidence of an order for non-violent bilateral soft wrist restraints on 11/04/22.

This finding was confirmed in an interview with Staff A on 11/08/22 at 1:20 PM.

Based on medical record review, staff interview, and policy review, the hospital failed to ensure the condition of the patient who is restrained was monitored by a physician, other licensed practitioner or trained staff for two of six patients reviewed with restraints (Patient #3 and #5). The total sample was ten records. The active census was 339.

Findings include:

Review of the policy titled, Restraint and/or Seclusion, revised 12/2021, revealed reassessment and monitoring for non violent/non self destructive restraints includes the following; the level of distress/agitation monitored every four hours under ongoing clinical justification, circulation/skin every two hours, blood pressure, pulse, temperature, and respirations every four hours, range of motion every two hours while awake, hydration/nutrition every two hours while awake, and elimination every two hours while awake.

1. Review of the medical record for Patient #3 revealed an admit date of 10/27/22 with diagnoses to include hyponatremia and concern for alcohol withdrawal. Review of the restraint flow sheets revealed the patient was placed in non-violent bilateral soft wrist restraints and a posey vest on 10/28/22 at 5:06 PM. Review of the two hour restraint monitoring included circulation/skin integrity assessed, range of motion, hydration, nutrition, and elimination. Review of the restraint flowsheets revealed on 10/29/22 the patient was assessed/monitored at 11:47 AM with no further assessments until 4:39 PM and then no further assessments until 8:00 PM. Further review revealed on 10/31/22 the patient was assessed/monitored at 6:00 AM with no further assessments and/or monitoring completed until all restraints were discontinued on 10/31/22 at 10:00 PM.

This finding was confirmed in an interview with Staff B on 11/08/22 at 9:04 AM.

2. Review of the medical record for Patient #5 revealed an admit date to the intensive care unit on 10/30/22 at 6:56 PM for an ongoing headache following a recent Covid-19 diagnosis. Review of the physican orders revealed the patient was placed in non-violent bilateral wrist restraints on 10/31/22 at 4:00 PM. Review of the two hour restraint monitoring included circulation/skin integrity assessed, range of motion, hydration, nutrition, and elimination. Review of the restraint flowsheets revealed on 11/05/22 the patient was assessed at 6:00 PM with no further assessment until 11/06/22 at 8:00 AM.

This finding was confirmed in an interview with Staff B on 11/08/22 at 10:04 AM.