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Based on documentation review and interviews, the hospital failed to ensure the face-to-face physician examination was completed according to hospital policies and procedures for 1 of 3 patients (P7) who required a restraint application.

Findings include:

P7 's medical record review of the history and physical, dated 8/7/14, noted P7 presented to the emergency department due to suicidal ideation and engaging in self-injurious behaviors. P7 was transferred to an adult mental health unit of the hospital. The history and physical also noted P7 had diagnoses including borderline personality disorder, post-traumatic stress disorder, hallucinations, and suicide attempts.

Review of P7 's documentation flow sheets for restraint and seclusion, dated 8/14/14 at 1820 (6:20 p.m.), noted P7 had imminent self-destructive behavior requiring the application of four point restraints. Staff obtained a physician order for application of the restraints. Review of the progress notes revealed a Debrief Note, dated 8/14/14 at 2005 (8:05 p.m.). Review of the progress notes revealed no face to face evaluation was completed by a physician.Review of P7 's documentation flow sheets for restraint and seclusion, dated 8/18/14 at 2141 (9:41 p.m.), revealed P7 exhibited self- injurious behavior and was not able to contract with staff for safety, staff obtained a physician order and applied the restraints. Review of the flow sheets, dated 8/18/14 at 2245 (10:45 p.m.), revealed staff discontinued P7 's restraints. Review of the progress notes, dated 8/18/14 at 2246 (10:46 p.m.), revealed the staff debriefed after they discontinued P7 's restraints. Review of the progress notes also revealed no face to face evaluation was completed by a physician.An interview conducted on 12/3/14 at 1:30 p.m. with Nurse Manager E and verified no face to face evaluation documentation was noted in P7 's medical record following restraint applications on 8/14/14 at 1820 (6:20 p.m.) and 8/18/14 at 2141 (9:41 p.m.). Nurse Manager E verified a face to face physician evaluation of the patient was to be completed within one hour of applying restraints on a patient.An interview was conducted on 12/4/14 at 10:00 a.m. with Clinical Practice Coordinator G and she verified further review of P7 's medical record revealed no face to face evaluations were completed by a physician within one hour of restraint application according to the hospital policy and procedure on 8/14/14 at 1820 (6:20 p.m.) and 8/18/14 at 2141 (9:41 p.m.).Review of the hospital policy and procedure, Restraints/Seclusion - Management of Violent and/or Self-Destructive Behavior, effective February 2013, noted Face-to-Face Assessment (In-person Evaluation) when restraint or seclusion is ordered, the patient must be assessed face-to-face by an LIP (licensed independent practitioner) within one hour of the initiation of the intervention. ...The face-to-face assessment includes both a physical and behavioral assessment of the patient that must be conducted by a qualified practitioner within the scope of practice for that practitioner.