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LEWISGALE MEDICAL CENTER
PATIENT RIGHTS: RESTRAINT OR SECLUSION
Tag No.: A0171
Based on medical record and facility document review, the facility staff failed to renew a violent restraint physician order within four (4) hours for one (1) of six (6) patients included in the survey sample. (Patient #1)
The findings include:
On 12/26/23 at 2:10 p.m., a review of six (6) sampled patient records was conducted. Staff Members #1 (SM1) and #2 (SM2) navigated the review of the medical records.
On 12/9/23 at 7:12 p.m., violent restraints were ordered for Patient #1 (Pt.1). There was no documentation that the restraints were removed. The next physician order for Pt.1 violent restraints was documented on 12/9/23 at 12:03 a.m., fifty-one (51) minutes after the first order expired.
A review of the facility's policy "Patient Restraint/Seclusion", last revised 7/2023 stated in part:
"...5B. Order for Restraint with Violent or Self-Destructive Behavior...Orders for restraint or seclusion must not exceed: 1. Four hours for adults, aged 18 years and older...b. To continue restraint or seclusion beyond the initial order duration, the RN...calls the ordering physician or licensed practitioner...to obtain a renewal order. Renewal orders for restraint/seclusion may not exceed: 1. Four hours for adults, aged 18 years or older...".
The findings were discussed with Staff Members #2, #4, #14 and #15 at the exit conference on 12/27/23 at 12:15 p.m.
PATIENT RIGHTS: RESTRAINT OR SECLUSION
Tag No.: A0178
Based on interview, medical record and facility document review, the facility staff failed to provide a timely one hour face to face with one (1) of six (6) patients in restraints included in the survey sample.
The findings include:
On 12/26/23 at 2:10 p.m., a review of six (6) sampled patient records was conducted. Staff Members #1 (SM1) and #2 (SM2) navigated the review of the medical records.
On 12/9/23 at 7:12 p.m., violent restraints were ordered for Patient #1 (Pt.1). The assigned Registered Nurse documented that Pt.1's restraints were placed on 12/9/23 at 7:30 p.m. The facility's second tier review was documented as complete at 10:45 p.m. on 12/9/23 by another RN, three (3) hours and thirty-three minutes after the restraints were placed on Pt.1. During the medical record review, Staff Member #1 stated that the Second Tier of Review was the one (1) hour face to face with the patient in restraints.
A review of the facility's policy "Patient Restraint/Seclusion", last revised 7/2023, stated in part:
"...5. Second Tier of Review: 1. A member of nursing administration/management (e.g., nursing supervisor/manager, charge nurse, manager/director, CNO, etc.) will review the need for restraint or seclusion with the RN who has determined that the patient requires restraint or seclusion. The second tier of review will occur with the initial application of restraint or seclusion...".
The findings were discussed with Staff Members #2, #4, #14 and #15 at the exit conference on 12/27/23 at 12:15 p.m.