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Based on observations, staff interviews and record reviews, the facility failed to secure bilateral soft wrist restraints properly to the bed-frame for 1(#3) of 2 sampled patients reviewed with restraints.

The findings include:

Observation of Patient #3 on 3/16/15 at 12:54 pm revealed the patient was restrained in bed. The patient had soft restraints to both wrists. At this time, Patient #3 was asleep in bed. The restraints were secured to a device that raised and lowered the bed. This device was also used to make the bed flat in event of CPR. The patient was on a Hill Rom Century CC bed.

Interview with Employee D on 3/16/15 at 12:56 pm revealed the patient was NPO (nothing by mouth). The nurse was asked to explain why the restraints were secured to an object that was on the bedframe. The nurse did not have an answer. The question was asked, where should you tie the restraints? The nurse stated that the restraints should be secured to the bedframe. The nurse did not have a response as to why both wrist restraints were secured to the device on the bedframe. The Manager was called to the room. The Manager examined the device and stated that the restraints should have been secured to the movable part of the bedframe. Employee B contacted the Staff Educator via text. The Clinical Educator replied and stated that, "The restraint is always attached to an immovable part of the bed- frame. We do not have a specific area, because beds are different and everyone is a different size." Usually, there is a hole on the underside of the bed; you can put the restraint through the hole to secure, and we do not teach to apply to the CPR levers. It is not taught in Skills Fair or Orientation."

Review of the Policy and Procedures for Physical Restraint of Patient (Policy No. 0600.009) does not address how the restraint should be secured to the bed.

Review of the Annual RN Competency Test Reference Guide dated 2014 for review of Restraints (Policy #0600.009) revealed the same information in the policy for restraints and does not address how staff should secure the restraints to the bed.

Review of the Power Point education on Restraints & Seclusion for nursing staff, revised 11/2014 under Protocol/Procedure, revealed restraints are secured with a "quick release" knot or buckle. They are secured only to the moveable parts of the bed (not side-rails, but bedframe).