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Based on observation one of 15 patient charts was observed left open and unattended in a wall mounted storage device, in the hallway of one in-patient unit. Findings include:

On 7/28/10 at approximately 0920 the medical record for one patient (#15) was observed to be wide open and unattended in a wall mounted chart holding device on the 5th floor in-patient unit. This finding was confirmed by the Director of Critical Care.

On 7/27/10 at 1130 review of patient #14's medical record revealed a 5/29/10 order for a vest, bilateral soft wrists restraints, and bilateral soft ankle restraints. The only reason noted on the physician's order was "confusion/disorientation." Documentation of failed attempts to use less restrictive interventions were not noted. The physician did not note the time that the order was signed. These findings were confirmed by the Director of Critical Care Services.

Per facility policy NSG0233, titled "Restraints in Non-Psychiatric Setting", dated 8/09, under Procedures:
1 c. "The order must include the specific type of restraint, specific duration of restraint and the reason for the restraint (behavior observed).
1 j. "Documentation will include the patient's behavior exhibited, clinical justification, type of restraint and alternatives tried."

These findings were confirmed by the Director of Critical Care Services.

Based on observation, interview and record review it was determined that two of four patients (#9 and 14) who were physically restrained did not have physician monitoring as specified in the hospital's policy. Findings include:

Facility policy NSG0233, titled "Restraints in Non-Psychiatric Setting,"dated 8/09, under "Procedure," states:
1 d. "All orders must be signed by a physician, timed and dated."

On 7/26/10 at approximately 1100, patient #9 was observed in bed with bilateral wrist restraints tied to the bed frame. The patient was resting quietly. Record review revealed an order for bilateral soft wrist restraints noted at 0700 on 7/24/10. The physician did not time his signature on the order form. On 7/25/10 the physician again ordered bilateral soft writst restraints and failed to note the time signed. On 7/26/10 the time of the physicians's signature is unclear. The "order time" section of the form was also left blank. Only a time noted was documented.

On 7/27/10 at 1130, review of patient #14's medical record revealed a 5/29/10 order for a vest, bilateral soft wrist restraints, and bilateral soft ankle restraints. The physician did not note the time that the order was signed. On 6/3/10 a phone order for restraints was taken at 2343, noted on 6/3/10, and signed by a physician but not dated or timed. On 6/4/10 a physicians's order for bilateral soft wrist restraints was not dated or timed by the physician who signed the order. These findings were confirmed by the Director of Critical Care Services.

Based on observation one of 15 patient charts was observed left open and unattended in a wall mounted storage device, in the hallway of one in-patient unit. Findings include:

On 7/28/10 at approximately 0920 the medical record for one patient (#15) was observed to be wide open and unattended in a wall mounted chart holding device on the 5th floor in-patient unit. This finding was confirmed by the Director of Critical Care.

On 7/27/10 at 1130 review of patient #14's medical record revealed a 5/29/10 order for a vest, bilateral soft wrists restraints, and bilateral soft ankle restraints. The only reason noted on the physician's order was "confusion/disorientation." Documentation of failed attempts to use less restrictive interventions were not noted. The physician did not note the time that the order was signed. These findings were confirmed by the Director of Critical Care Services.

Per facility policy NSG0233, titled "Restraints in Non-Psychiatric Setting", dated 8/09, under Procedures:
1 c. "The order must include the specific type of restraint, specific duration of restraint and the reason for the restraint (behavior observed).
1 j. "Documentation will include the patient's behavior exhibited, clinical justification, type of restraint and alternatives tried."

These findings were confirmed by the Director of Critical Care Services.

Based on observation, interview and record review it was determined that two of four patients (#9 and 14) who were physically restrained did not have physician monitoring as specified in the hospital's policy. Findings include:

Facility policy NSG0233, titled "Restraints in Non-Psychiatric Setting,"dated 8/09, under "Procedure," states:
1 d. "All orders must be signed by a physician, timed and dated."

On 7/26/10 at approximately 1100, patient #9 was observed in bed with bilateral wrist restraints tied to the bed frame. The patient was resting quietly. Record review revealed an order for bilateral soft wrist restraints noted at 0700 on 7/24/10. The physician did not time his signature on the order form. On 7/25/10 the physician again ordered bilateral soft writst restraints and failed to note the time signed. On 7/26/10 the time of the physicians's signature is unclear. The "order time" section of the form was also left blank. Only a time noted was documented.

On 7/27/10 at 1130, review of patient #14's medical record revealed a 5/29/10 order for a vest, bilateral soft wrist restraints, and bilateral soft ankle restraints. The physician did not note the time that the order was signed. On 6/3/10 a phone order for restraints was taken at 2343, noted on 6/3/10, and signed by a physician but not dated or timed. On 6/4/10 a physicians's order for bilateral soft wrist restraints was not dated or timed by the physician who signed the order. These findings were confirmed by the Director of Critical Care Services.