HospitalInspections.org

Based on record review, staff interview, and review of the facility policies the hospital failed to ensure that a physician order was obtained daily for the use of a medical restraint (A soft wrist restraint to protect the feeding tube from being removed when the patient was confused.) for 1 of 2 medically restrained patients (Patient 1). The facility policy requires a daily order for the use of restraints.

Findings are:

Review of Pt 1's medical record revealed that Pt 1 was admitted on 8/26/17 for a fractured hip requiring surgery. Patient 1 had a history of dementia (A confused mental state.) and while hospitalized developed swallowing difficulties. On 9/2/17 an order was received to provide feedings via a feeding tube (Dubhoff Tube) inserted through the nare into the stomach to provide nutrition. Due to Patient 1's dementia the physician ordered a medical restraint (soft wrist restraint) on 9/2/17 at 1655 (4:55 PM) to protect the patient from dislodging the feeding tube. Patient 1's medical record lacked the daily physician order to continue the medical restraint on the following days: 9/3/17 and 9/8/17 through 9/12/17. (6 out of 11 days)

Review of the restraint policy titled "Restraint Management in Acute Care" dated as last revised 6/2015, revealed that a non violent, nonself-destructive restraint (medical restraint) "Must be renewed every calendar day; use the campus-specific, medically-approved (Hospital) physician order set."

An interview on 11/29/17 at 1:30 PM with Registered Nurse C (RN C -assisting with record review) verified Patient 1's medical record lacked the renewal orders for the medical restraint on 9/3/17, and 9/8/17 through 9/12/17.

Based on record review, policy review and staff interviews, the facility failed to ensure four of four Physicians who were privileged
and trained to order patient restraints had a signed attestation of restraint and seclusion knowledge every two years at credentialing as required per facility policy.

A. Review of facility nursing policy #3013899 - Restraint Management in Acute Care originated February 2014
and last revised June 2015, revealed in Paragraph F - Physicians authorized to order restraint and seclusion must have working knowledge of hospital policy regarding the use of restraint and seclusion and sign an attestation every two years at credentialing.

Interview with Credentialing Coordinator on 11/30/17 at 11:14 am revealed that this nursing policy was not reviewed by Medical Staff Office and therefore were unaware of the requirement for every two year attestation during physician credentialing process.

B. Review of Four Physicians (Medical Doctor- MD) with current restraint ordering privileges/practices MD- A, B, C and D
failed to have a signed attestation of the restraint and seclusion policy of the hospital at time of their re-application for credentialing.
MD - A had credentialing completed September 2016.
MD - B had credentialing completed February 2017.
MD - C and D were providers for the inpatient psychiatric unit and failed to have facility policy attestation of restraint and seclusion knowledge every two years.