HospitalInspections.org

Based on interview and document review the facility failed to submit a timely report for a patient death associated with the use of restraints for 1 of 2 patients (#1) reviewed for deaths associated with the use of restraints resulting in the potential for poor clinical outcomes. Findings include:

On 08/31/21 at approximately 1200 a review of Patient (Pt) #1's record revealed the following information:

A log titled, "Death In Restraints Log" indicated Pt #1 died on 05/01/21 and the death was associated with the use of soft medical restraints applied to both wrists and both ankles.

A death certificate with filing date of 05/10/21 that indicated Pt #1 was pronounced dead on 05/01/21 at 0752.

A Centers for Medicare & Medicaid Services (CMS) Form 10455 titled, "Report Of A Hospital Death Associated With The Use Of Restraint Or Seclusion" that indicated Pt #1's date and time of death was 05/01/21 at 0752. This form indicated the date and time the form was submitted was 05/18/21 at 1711.

During an interview with the Director of Patient Services (RN D) on 08/31/21 at approximately 1220, RN D was unable provide a clear answer why it took the facility over 17 days to submit form 10455 to CMS.

Review of facility policy titled, "Restraint And Seclusion, Use Of" last revised 06/23/20 indicated, under section 5.5 Reporting of Deaths Associated with the use of Restraints and/or Seclusion, indicated "5.5.2.6. Deaths ordinarily shall be reported to CMS Regional Office by close of business day following patient death.".