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Based on interview and document review, the hospital failed to ensure a patient and his representative were provided the right to be involved to develop and implement the treatment plan for 1 of 10 patients (P1) reviewed, when staff used chemical and physical restraints on the patient who had dementia and had an identified healthcare power of attorney (POA) but the POA was not informed of or involved in the treatment change decision.

Findings include:

P1's history and physical (H&P) dated 10/9/2018, revealed P1 was admitted to the hospital on 10/9/2018, after a fall at home and experienced a closed head injury. P1 had a history that included a recent stroke and a seizure disorder. The patient had a history of hospital delirium. The H&P indicated that because the patient had a history of hospital delirium, the staff should avoid the use of antipsychotics, anticholinergics, benzodiazepines, and opiates. Nursing notes, dated 10/9/2018, at 7:50 p.m. revealed that P1 was placed in 5 point soft restraints and given two doses of Haldol (antipsychotic), after he began to yell, tried to get out of bed, pulled out his IV, and was not able to follow commands. P1 was on 1 : 1 staffing for safety prior to the initiating of the restraints. Nursing flow sheets dated 10/9/2018 and 10/10/2018, revealed the patient remained in restraints until 12:00 p.m. the next day 10/10/2018, after his family came to the hospital and requested the restraints be removed. The patient calmed after his family arrived and the restraints were removed.

During an interview on 7/29/2020, at 2:40 p.m., P1's family member stated that P1 had dementia, and his family was his healthcare POA. Although the hospital had the information related to the POA designation, no one from the hospital contacted the family the evening of 10/9/2018, to let them know he was agitated and that they planned to restrain and medicate him. The family stated when they arrived around noon on 10/10/2018, the patient was in 5 point restraints, and was agitated. The family requested the restraints be removed. Staff then removed the restraints, and the patient was calm, and walked around the unit. The family stated that if they had been informed that P1 was agitated, they would have come to the hospital to calm him and the restraints and medications would not have been necessary. The family stated, as family and POA for the patient who had dementia, they feel they should have been informed of the patient's agitation and the treatment plan change that included the use of restraints and medication.

During an interview on 7/29/2020, at 11:50 a.m., Administrative registered nurse (RN)-D, confirmed there was no evidence P1's family and POA were informed of the treatment decisions to initiate restraints and antipsychotic medications. It would have been appropriate for the family and POA to be informed of those changes at the time, or shortly after they occurred.

The policy titled Patient Rights and Responsibilities, dated October 2018, and provided by hospital staff revealed under the section titled Policy Statement:

Patients may exercise all rights unless the exercise of those rights would be a danger to the patient and/or others, infringe upon the rights of other patient or is contraindicated for medical, safety or programmatic reasons...Adult patients who are conscious and have decision making capacity have the right to accept or refuse medical care, treatment or procedures according to established organizational procedures. A designated substitute decision maker has the right to accept or refuse medical care, treatment or procedures on behalf of the patient who lacks decision making capacity.