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CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER
PATIENT RIGHTS: RESTRAINT OR SECLUSION
Tag No.: A0168
Based on medical record review, staff interview, and review of the facility's policy number CPC 1-214 titled "Restraint: Violent and Non-Violent", it was determined the hospital failed to ensure one of two patients having restraints applied (Patient #4) had a written physician order for the use of a mechanical restraint. The sample size was 10. The hospital census was 56.
Findings include:
The electronic medical record for Patient #4 was reviewed with Staff A on 11/28/12 at 12:00 PM. Patient #4, a was admitted on 11/16/12 to Unit P3 North with a diagnosis of Bipolar 1. The intake assessment documented the patient had tried to harm him/her self, was physically aggressive with parent, and attempted to run away from home. The nursing notes documented the patient was restrained by use of a physical hold on 11/21/12 at 08:29 P.M. for attempting to harm him/her self by placing a cord around his/her neck. At 8:33 P.M. the patient was placed in a four (4) point mechanical restraint. There was no physician order for the use of the mechanical restraint.
This finding was verified with Staff A on 11/28/12 at 12:35 PM.
In addition, on 11/22/12 at 9:26 PM, the patient was placed in a four (4) point mechanical restraint for being out of control, charging staff, attempting to grab staff's badge, and attempting to go AWOL (leave the unit without permission). There was no physician order for the use of the mechanical restraint.
This finding was verified with Staff A on 11/28/12 at 12:35 P.M.
The facility's policy number CPC 1-214, titled "Restraint: Violent and Non-Violent" was reviewed on 11/29/12. The policy at 4.6 "Orders" number 4.6.1 stated " Restraint must be used in accordance with the order of a physician or an Advanced Practice Nurse (APN)." In addition, at 4.6.3 the policy stated " in emergency situations when it is not practical to obtain the physician order prior to the initiation because of the situation demanding an immediate response to protect the safety of the patient or others, the order from the physician or APN must be obtained as soon as practical, but not longer than one (1) hour after initiation of restraint. "