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Based on an observation of the emergency room, it was determined the hospital failed to ensure the safety of both patients and visitors within the emergency department to be free from injury resulting from unsecured sharps.

During observation of the emergency room, a supply cart containing needles and IV start materials within a nursing station was noted to be unsecured and the drawers were able to be opened. While this cart was in the nursing station, it could be accessed by patients or visitors walking by. An exam/treatment room was also checked, the supply cart in that room was also unsecured. In addition, there was a procedure cart in the main ED that was unlocked. A pediatric training code cart in one of the ED pod hallways containing sharps was also unlocked.

Based on the review of 8 open and 4 closed medical records, it was determined that the hospital failed to ensure that all episodes of restraints for one patient had physician or LIP orders.

Patient #2 was an elderly patient who presented to the hospital due to acute delirium, and attempt to elope from residence. Patient #2 was evaluated and found to require admission to treat the underline condition causing the delirium. Review of the patient medical record revealed incomplete documentation of four restraint episodes, with only two of these four restraint episodes having a physician or LIP order. The first restraint episode, on day of admission, was for violent restraints and had an order. In the second episode, the patient was documented as unsafe due to wandering in room. Patient was placed in restraint for an unspecified length of time and lacked an order and documentation. For the third episode, restraints were applied for an unspecified time and removed, the patient was noted as being combative and refused to go to bed at 2200. Three hours later at 0100 patient#2 was noted as being agitated and getting out if bed. The patient was placed again in two point restraints and given an antipsychotic medication via intramuscularly injection, after which the restraints were removed. No physician or LIP order were found in the record for restraint episodes two and three.

Half of the restraint episode imposed on patient #2 lack corresponding orders in the patient's medical record. The staff failed to provide oversight in ensuring that the application and use of restraints were ordered by a physician or other licensed practitioner.

Based on the review of 8 open and 4 closed medical records, it was determined that the hospital failed to ensure that all patients placed in violent restraints received a face to face evaluation within 1 hour of restraint initiation for one open medical record.

Patient #2 an elderly patient presented to the hospital due to acute delirium, and attempt to elope from residence. The patient was evaluated and found to require admission to treat the underline condition causing the delirium. Per medical record documentation the patient was placed in to 2-point bilateral upper extremity restraints at 1238 and remained until 2100 on day of admission. The orders for Violent Restraints details indicated that the patient was hitting/punching, kicking, lunging/ thrashing, and a danger to self and others. Patient #2 was in violent restraints for nine hours without receiving a face-to-face assessment.

Based on review of 8 open and 4 closed medical records, it was determined that the hospital failed to maintain patient #6 record with the information necessary to monitor the patient's condition.

Patient #6 was a 50+ year old patient who presented to the emergency department via ambulance for alcohol intoxication. Patient# 6 was triaged at 1616 and assigned an ESI of 2. Vital signs at 1616 were stable. Per record review there was no documentation found regarding patient's care until the next day. At 0607 vital signs were documented. An RN ED assessment was documented at 0656. A provider documented their assessment at 0729. When asked the hospital staff where the patient was during the time in-between, it was reported the patient was in a triage room overseen by the Flow Chief RN, a nurse assigned to triage patients coming in via ambulance. Patient was reported to be sleeping and sobering up during that time. However, this was not documented in the record.