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Based on a review of four grievance files, it was determined that the hospital failed to provide 1 of 4 grievances with a written notice of resolution.

Grievance #4 was opened in May 2017. A letter was sent shortly after informing the complainant that Patient Advocacy will follow up within 30 days. A resolution letter was not found during the on-site survey.

Based on review of two patient records in which restraints were applied, it was determined that the hospital failed to re-order a restraint after the 4 hour maximum order limit ended for 1 of the 2 patients.

Patient #8 was emergency petitioned to the hospital's emergency department. Patient #8 was placed in 4 point violent restraints at 1748 and released from violent restraints at 2216. There was no renewal order of the original violent restraint order found in the medical record. This was past the 4 hour maximum limit for adults.

Based on review of two patient records in which restraints were applied, it was determined that the hospital failed to use appropriate release criteria from restraints for 1 of the 2 patients.

Review of Patient #1's pediatric emergency department record revealed patient had three physical restraint episodes during their admission. The criteria for release documented on the "Self-destructive, Violent Restraint Face to Face Evaluation" flowsheet for two physical restraints had release criteria that stated "Safely follow directions" and "Calm/ quiet per RN assessment."

The hospital used inappropriate criteria for release from restraint, where the only criterion is the cessation of the dangerous behavior which necessitated the intervention.

Based on review of two patient records in which restraints were applied, it was determined that the medical staff failed to 1) adequately document all of the components of the face-to-face for 1 of the 2 patients and 2) obtain a face-to-face for 2 of 2 patients.

Patient # 1 was emergency petitioned to the hospital's pediatric emergency department. Patient #1 had three separate physical restraint episodes. A face to face evaluation was not found in the medical record for physical restraint episode #1. Restraint episode #2 and #3 had a face to face evaluation documented in the chart but did not address the patient's reaction to the intervention.

Patient #8 was emergency petitioned to the hospital's emergency department. Patient was placed in 4 point violent restraints once during their time there. Patient was placed in violent restraints at 1748 and released at 2216. A face to face evaluation was not found in the medical record for this episode.