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Based on record reviews and interview, the hospital failed to ensure the type of restraint that was ordered was the type of restraint used for 2 (two) of 5 (five) patients reviewed (Patient #3R and Patient #4R).

Findings:

1. On 6/26/2021 at 8:50 PM, a hand mitt was ordered to be applied to the Patient #4R's right hand and left hand.

Documentation in the patient's record indicated soft wrist restraints were applied to the patient's right wrist and left wrist from 6/26/2021 at 8:50 PM through 6/27/2021 at 6:00 AM.

Based on the above, the patient was not restrained with the type of restraint that was ordered by the physician as hand mitts were ordered and soft wrist restraints were used.

2. On 7/12/2021 at 9:42 AM, a hand mitt was ordered to be applied to the Patient #3R's right hand and left hand.

Documentation in the patient's record indicated soft wrist restraints were applied to the patient's right wrist and left wrist from 7/12/2021 at 9:42 AM through 7/13/2021 at 7:43 AM.

Based on the above, the patient was not restrained with the type of restraint that was ordered by the physician as hand mitts were ordered and soft wrist restraints were used.


On 7/16/2021 at 1:10 PM, the above findings were reviewed with the Director of Accreditation and Regulatory Affairs.

Based on document reviews and interview, the hospital failed to ensure the Attending Physician was consulted as soon as possible when another provider ordered restraints for 2 (two) of 5 (five) patients reviewed (Patient #3R and Patient #5R).

Findings:

The Maine Medical Center "Use of Restraints" Policy and Procedure, updated 4/2020, states, "...If anyone other than the patient's provider orders restraints, the patient's provider must be notified as soon as possible".

1. There was no evidence in Patient #3R's medical record that the attending physician was consulted as soon as possible after the following eleven (11) orders for restraints: on 7/1/2021 at 8:50 AM, PA # 2 ordered bilateral soft wrist restraints; on 7/3/2021 at 9:21 AM, Nurse Practitioner ("NP") #2 ordered bilateral soft wrist restraints; on 7/4/2021 at 12:47 PM, NP #2 ordered bilateral soft wrist restraints; on 7/5/2021 at 11:06 PM, PA #1 ordered bilateral soft wrist restraints; on 7/8/2021 at 9:25 AM, Physician Assistant-Certified ("PA-C") #3 ordered bilateral soft wrist restraints; on 7/8/2021 at 11:52 PM, PA-C #3 ordered bilateral soft wrist restraints; on 7/10/2021 at 1:00 AM, PA-C #1 ordered bilateral soft wrist restraints; on 7/11/2021 at 12:27 AM, PA-C #1 ordered bilateral soft wrist restraints; on 7/12/2021 at 9:42 AM, PA-C #4 ordered bilateral hand mitt restraints; on 7/13/2021 at 10:03 AM, PA #1 ordered bilateral hand mitt restraints; and on7/14/2021 at 9:29 AM, PA-C #4 ordered bilateral hand mitt restraints.

2. There was no evidence in Patient #5R's medical record that the attending physician was consulted as soon as possible after the following eight (8) orders for restraints: on 6/13/2021 at 11:38 PM, PA-C #1 ordered bilateral soft wrist restraints; on 6/15/2021 at 1:52 AM, PA-C #4 ordered bilateral soft wrist restraints; on 6/22/2021 at 5:33 AM, PA-C #2 ordered bilateral hand mitt restraints; on 6/22/2021 at 10:46 AM, PA-C #4 ordered bilateral hand mitt restraints; on 6/23/2021 at 8:47 AM, PA-C #4 ordered bilateral hand mitt restraints; on 6/25/2021 at 11:44 PM, PA-C #1 ordered bilateral hand mitt restraints; on 6/27/2021 at 9:26 PM, PA-C #1 ordered bilateral hand mitt restraints; and on 6/29/2021 at 2:21 AM, NP #1 ordered bilateral soft wrist restraints.


On 7/16/2021 at 1:10 PM, the above findings were confirmed with the Director of Accreditation and Regulatory Affairs.

Based on record reviews and interview, the hospital failed to ensure a renewal order was obtained every twenty-four (24) hours, as required by the order's timeframe, when the restraint continued after the twenty-four (24) hours for two (2) of five (5) patients reviewed (Patient #3R and Patient #5R).

Findings:

The Maine Medical Center "Use of Restraints" Policy and Procedure, updated 4/2020, states "The order for nonviolent non self-destructive restraint must be renewed once per calendar day..."

The "Process Instructions" for ordered non-violent or non-self-destructive restraints states, in part, "the duration should not exceed 24 hours. Please set the start time to be the time the restraints are initiated" and "Orders must be renewed every 24 hours or reordered if discontinued".


1. On 7/11/2021 at 12:27 AM, a wrist restraint was ordered to be applied to Patient #3R's right wrist and left wrist continuously for twenty-four (24) hours. This order, which was for non-violent or non-self-destructive reasons, would expire on 7/12/2021 at 12:27 AM and would need to be renewed if the restraint was to continue.

Documentation in the patient's record indicated this patient remained in restraints continuously from 7/12/2021 at 12:28 AM through 7/12/2021 at 9:42 AM without an order. The next order for restraint was obtained on 7/12/2021 at 9:42 AM which exceeded the twenty four (24) hours as indicated in the provider's order dated 7/11/2021 at 12:27 AM.

2. On 6/13/2021 at 10:38 PM, a wrist restraint was ordered to be applied to Patient #5R's right wrist and left wrist continuously for twenty-four (24) hours. This order, which was for non-violent or non-self-destructive reasons, would expire on 6/14/2021 at 10:38 PM and would need to be renewed if the restraint was to continue.

Documentation in the patient's record indicated this patient remained in restraints continuously from 6/14/2021 at 10:39 PM through 6/15/2021 at 1:52 AM without an order. The next order for restraint was obtained on 6/15/2021 at 1:52 AM which exceeded the twenty four (24) hours as indicated in the provider's order dated 6/13/2021 at 10:38 PM.

3. On 6/24/2021 at 8:45 AM, a hand mitt restraint was ordered to be applied to Patient #5R's right hand and left hand continuously for twenty-four (24) hours. This order, which was for non-violent or non-self-destructive reasons, would expire on 6/25/2021 at 8:45 AM and would need to be renewed if the restraint was to continue.

Documentation in the patient's record indicated this patient remained in restraints continuously from 6/25/2021 at 8:46 AM through 6/25/2021 at 10:44 PM without an order. The next order for restraint was obtained on 6/25/2021 at 10:44 PM which exceeded the twenty-four (24) hours as indicated in the provider's order dated 6/24/2021 at 8:45 AM.

4. On 6/25/2021 at 10:44 PM, a hand mitt restraint was ordered to be applied to Patient #5R's right hand and left hand continuously for twenty-four (24) hours. This order, which was for non-violent or non-self-destructive reasons, would expire on 6/26/2021 at 10:44 PM and would need to be renewed if the restraint was to continue.

Documentation in the patient's record indicated this patient remained in restraints continuously from 6/26/2021 at 10:45 PM through 6/27/2021 at 9:25 PM without an order. The next order for restraint was obtained on 6/27/2021 at 9:26 PM which exceeded the twenty-four (24) hours as indicated in the provider's order dated 6/25/2021 at 10:44 PM.

5. On 6/27/2021 at 9:26 PM, a hand mitts restraint was ordered to be applied to Patient #5R's right hand and left had continuously for twenty-four (24) hours. This order, which was for non-violent or non-self-destructive reasons, would expire on 6/28/2021 at 9:26 PM and would need to be renewed if the restraint was to continue.

Documentation in the patient's record indicated this patient remained in restraints continuously from 6/28/2021 at 9:27 PM through 6/29/2021 at 2:21 AM without an order. The next order for restraint was obtained on 6/29/2021 at 2:21 AM which exceeded the twenty-four (24) hours as indicated in the provider's order dated 6/27/2021 at 9:26 PM.


On 7/16/2021 at 1:10 PM, a surveyor confirmed the above findings with the Director of Accreditation and Regulatory Affairs.

Based on document reviews and interview, the hospital failed to ensure staff completed annual restraint training and the documentation was contained in a staff member's personnel record for two (2) of ten (10) staff reviewed who had been involved in a patient restraint (Medical Doctor #1 and Registered Nurse #1).

Findings:

The hospital's "Use of Restraints" policy and procedure, updated 4/2020, states, "All primary staff who are directly involved with the application of a restraint, implementation of seclusion, or are providing primary care, monitoring, or assessment of patients in restraints or seclusion will receive training annually based on their duties and responsibilities initially (prior to performing restraint application) and on an ongoing basis by individual site policy".

The hospital's policy "Definitions", dated 4/22/2020, defines "Annual" as, "One year from the date of last event, plus or minus 60 days. Annually is synonymous with yearly, once a year, every year, and every 12 months. Example: RN restraint e-learn was completed on April 1, 2020. The next annual e-learn should be completed between January 31, 2021 and May 31, 2021".

1. Medical Doctor ("MD") #1 ordered restraints for Patient #2R on 5/19/2021.

The surveyor requested to review DO #1's training records. The training record stated MD had completed training on restraints on 4/3/2020. Based on the hospital's policy, the MD would be required to complete his next training on restraints on or before 6/2/2021.

As of 7/16/2021, there was no evidence provided to the surveyor that indicated MD had completed training on restraints since 4/3/2020.

2. Registered Nurse ("RN") #1 was involved in the care of Patient 4R when he/she was in restraints on 6/26/2021.

The surveyor requested to review RN #1's training records. The training record stated the RN had completed training on restraints on 11/6/2019.

As of 7/16/2021, there was no evidence provided to the surveyor that indicated RN #1 had completed training on restraints since 11/6/2019.


On 7/16/2021 at 1:10 PM, the above findings were reviewed with the Director of Accreditation and Regulatory Affairs.