HospitalInspections.org

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Based on interview, record review, and review of hospital policies and procedures, the hospital failed to ensure that hospital staff members wrote orders for restraints which were specific to the type of restraint required and not on an "as needed" basis.

Failure to have physician orders for restraints specific as to type places patients at risk for not having appropriate re-evaluations based on their changing conditions.

Findings:

1. The hospital's policy and procedure, "Seclusion and Physical & Mechanical Restraint," Policy # PC.R.100, last reviewed on 01/17 showed that orders for restraints shall never be written as a standing order or on as needed basis (PRN).

2. On 07/21/17, Surveyor #3 reviewed the medical record of Patient #5 who was admitted on 06/27/17 for Acute Psychosis. On 07/11/17 at 11:30 AM, Patient #5 became verbally and physically aggressive and attempted to pour a cup of hot coffee on a peer.

3. The medical record review showed the following:

-On 07/11/17 at 11:30 AM, documentation on the "Restraint/Seclusion Progress Note" shows the staff called a "Code Gray" (a standardized Hospital Emergency Code that alerts all staff to potentially or actively combative persons) and the patient was placed in a physical hold and Mechanical 4-point Restraints were applied.

-On 07/11/17 at 11:30 AM, documentation on the "RN Assessment-Seclusion & Restraint Form" reflects the patient was placed in Physical Restraint, Mechanical Restraint and "transferred to a seclusion room".

-On 7/11/17 at 11:30 AM, a telephone order for Physical Hold, Seclusion and Mechanical 4-point Restraints was written. A physician assistant co-signed the order on 07/11/17 at 11:30 AM.

-On 7/11/17 at 12:05 PM, the original order was amended and the seclusion order check box was circled and "omit PJB 7/11@ 1205" was written on the physician order form.

-On 07/11/17 at 12:40 PM, documentation states, "Continue with seclusion with L (left) arm/hand and R (right) leg restraint in place."

- On 07/11/17 at 1:40 PM, documentation states, "Patient lying supine with L (left) arm and R (right) leg restraint in place. Discussed criteria for L (left) arm and R (right) leg restraint and seclusion release."

-On 07/11/17 at 2:45 PM, documentation on the "RN Assessment-Seclusion & Restraint Form" under the section titled "Release from Restraint/Seclusion," shows the patient was released from restraint/seclusion at that time.

4. On 07/21/17 at 1:36 PM, Surveyor #3 interviewed the Charge Nurse (Staff G) related to the physician order that reflected simultaneous orders for Physical Hold, and Seclusion, and 4-point Restraints. Staff G told the surveyor when the staff call the doctor they get what they need-in case including physical, mechanical, seclusion or chemical restraint.