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Based on observation, interview and record review the facility staffs failed to maintain Patients confidential medical information when the facility left computers, documents and the EKG monitor within view of visitors and other personnel not involved in the patient's care.

Findings Include,

Observations on the morning of 8/3/15 on the ICU and Medical Surgical Nursing units revealed (11) eleven incidents of patient information being left out for public viewing. (5) Five computers were left open displaying patient information (4) four charts were left laying open with patient information, a (1) computer disc with patient information and (2) patient's full names were displayed on the facilitiy's EKG monitors in a public access hallway. (Patients #4,5,6,7,8,9,10,11,12,13 and 14)

During an interview on the morning of 8/3/15 on the nursing units, Staff #8, RN stated "I was trained on HIPPA ...we need to protect patient information..."

During a tour on the morning of 8/3/15 on the nursing units, Staff #2 Senior Director of Nursing confirmed the findings.

Review of the facility provided document Patient - Rights and Responsibilities reflected, "... The patient rights are as follows: Receive care in a setting that respects your need for confidentiality, personal privacy, and security....Privacy and confidentiality of your health information, in accordance with existing law...."

Based on interview and record review the facility nurses failed to follow the Physician's orders when Patient #1 was placed in wrist restraints when the order was for a soft belt restraint.

Findings include:

Review of Patient #1's Physician's Orders dated 12/20/15 at 8:44 a.m. reflected "Restraint Violent Restraint Justification: Significant danger to others, trying to hit people, Restraint Type: Soft belt, Not to exceed 4 hours."

Review of the Security Code Gray documentation dated 12/20/15 at 8:42 a.m. reflected " ...secured the patients right arm ....Patient was placed into a restraint vest and relocated from the chair to the patient bed. Soft restraints were applied to the patient ...wrists ...."
At 9:40 a.m. reflected, "...patient had pulled her arms from the soft restraints....attempted to reapply the restraints and the patient attempted to hit the associate with her fist and kick with her legs....secured the patient right wrist and right ankle using twice-as-tough restraints....secured the patient left ankle....the patient spit....hitting him in the face and glasses. At no point did fluid make contact with...eyes. The patient continued to spit at staff until a mask was placed over the patient mouth. Patient's left arm was secured."

Review of the nursing documentation dated 12/20/15 at 9:00-9:15 a.m. reflected Soft limb left upper and Soft limb right upper and vest restraints were in place.

Review of the facility provided document Patient Care - Orders reflected, "...It is the policy of the Seton Healthcare Family (SHF) that patient care orders will be complete, clear, accurate, and legible, such that there is no ambiguity regarding the order....Orders will be assessed for ambiguity by all disciplines receiving them and be clarified prior to acting upon the order....5. Implement interventions as ordered and document in COMPASS where applicable...."

During an interview on the afternoon of 8/3/17 in the facility conference room Staff #3, Quality Specialist confirmed the findings and stated, "We now have a daily restraint order review, we look for appropriate orders...we educate the physicians and staff...."

Based on interview and record review the facility's nursing failed to readily recognize violent and self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member, or others when a violent patient was placed on non-violent restraints for greater than 4 hours, placing the patient at a higher risk for injury. (Patient #1)

Findings include:

Review of the facility provided document Patient Care - Orders reflected, "...It is the policy of the Seton Healthcare Family (SHF) that patient care orders will be complete, clear, accurate, ....Orders will be assessed for ambiguity by all disciplines receiving them and be clarified prior to acting upon the order.... 5. Implement interventions as ordered and document in COMPASS where applicable..."

Review of the facility provided document Restraints and Safety Alternatives - Use of - Medical/Surgical Acute Care Facilities (Dated 2015) reflected, ".... B. Restraint use procedures are separated into two distinct categories which are based on the reason and/or purpose for restraint use as follows:
1. Non-violent or non-self-destructive restraint is used to ensure the patient's safety and for the patient's well-being to promote healing and to ensure the continuation and effectiveness of medical, surgical or dental treatment; or,
2. Violent or self-destructive restraint is used when a RN assessment reveals an emergency exists; and, the patient's current violent or self-destructive behavior represents physical danger to self and/or others (including staff)....
Restraint Monitoring; includes visual check, assisting with range of motion, elimination, nutrition and hydration, and hygiene needs along with physical and mental comfort status.
o For non-violent restraint, monitoring occurs at a minimum every 2 hours or more frequently as determined by the patient's condition.
o For violent restraint, monitoring occurs through direct visual contact at a minimum of every 30 minutes or more frequently as determined by the patient's condition...."

Review of Patient #1's Physician Orders reflected
On 12/24/15 at 1:10 p.m. Renew Restraint Non-Violent Order Restraint Justification: Cognitive impairment interferes w/care, Restraint Type: Least Restrictive Approved Device
On 12/25/15 at 10:33 a.m. Renew Restraint Non-Violent Order Restraint Justification: Cognitive impairment interferes w/care, Restraint Type: Least Restrictive Approved Device.

Review of the facility provided Security Responded Code Gray (Violent or Aggressive Patient or Visitor) documentation reflected, "At about 1214 hrs on 12/24/15...observed getting out of her restraints ...the patient did cut into my wrist with her finger nails causing my wrist to bleed...the patient was screaming obscenities and spitting at staff...."

"On 12/24/2015 at approximately 0240...currently placed in 4 point restraints, but was removing the restraints. Patient's sister stated she was using her mouth to pry the restraints off....worked together to apply both restraints back to patients wrist....while holding patients right hand she attempted to bite my hands and then proceeded to scratch my right wrist and took a small chunk of flesh out of my left thumb drawing blood from both. I continued to restrain the patients hand ...."

"On Thursday 12/24/2015 at approximately 1942Hrs...Patient #1 was trying to leave her room and wasn't getting onto her bed. Patient #1 went into the bathroom, refused to come out on her own, and began to yell at all the staff (cursing)....holding her up under her arms, while ... supported her back . Patient #1 was then placed onto her bed and restraints were applied. During the application of the restraints patient #1 kept trying to assault staff, by scratching and biting at them....was placed into four point soft restraints without injury or medications given and still remains on Operation Safe Shift (O.S.S.) for aggressive and assaultive behavior.

"On Thursday 12/25/15 at approximately 0310 hrs....she began to swing at us and bite...continued to resist by trying to kick and scratch at staff....placed into four point restraints with a vest for her protection and the protection of others...."

Review of Patient #1's medical records did not reflect any medical treatments or procedures prior to the initiation of the restraints and the Physician and Nursing notes did not reflect any concerns for the discontinuation of medical treatments.

During an interview on the morning of 8/3/17 in the facility conference Staff #5, Risk Manager when asked why a patient with violent behavior was placed on non-violent restraint orders stated, "The patient was interfering with her medical treatment...we've updated our restraint policy...."