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PROVIDENCE ALASKA MEDICAL CENTER
PATIENT RIGHTS: RESTRAINT OR SECLUSION
Tag No.: A0179
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Based on record review, interview and policy review, the facility failed to ensure 1 patient (#9) out of 3 patients assessed for violent restraints, was seen face to face within 1 hour after the initiation of a restraint intervention. This failed practice had the potential to delay assessment of the patient's physical and behavioral status and potentially continue the restraint longer than necessary.
Record review on 6/16-17/21 revealed Patient #9 was admitted to the facility with diagnoses that included overdose and altered mental status. Further review revealed the Patient required 4-point (wrist and ankle) restraints secondary to dangerous behaviors towards others.
During an interview on 6/16/21 at 11:31 am, when asked about the restraint process, Licensed Nurse #1 stated the Physician would have performed a face-to-face assessment within one hour of the Patient being placed in restraints.
Review of Patient #9's "Violent-Self-Dest[ructive] Restraints" flowsheet, dated 4/5/21 at 3:15 am, revealed, under "Verified 1 Hr [hour] Face to Face Docu[mentation]," was answered "Yes." Further review revealed no documentation of the 1-hour face to face assessment in the Patient's medical record by the Physician.
During an interview on 6/17/21 at 10:25 am, the Manager Regional Accreditation stated the Physician was required to perform a 1-hour face to face assessment, and there should have been an assessment note in Patient #9's medical record.
Review of the facility's policy "Restraint Management," revised 4/2021, revealed "The LIP [Licensed Independent Practitioner] must conduct an in person a face-to-face assessment within 1 hour after a violent or self-destructive restraint application. The evaluation is included in their MD note. The evaluation addresses: a. The patient's immediate situation [;] b. The patient's reaction to the restraint and current situation [;] c. A comprehensive physical and psychological assessment to rule out any underlying issues ...; and d. The need to continue or remove the restraint."
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