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Based on interview and documentation review, it was determined the Hospital failed to ensure implementation of restraints was performed in accordance with hospital policy in 5 of 11 (Patient #1, #2, #3, #4 and #6) restraint patients medical records reviewed.

Findings included:

The Hospital policy that addressed restraints of patients was reviewed. The policy stated a written order is required in all cases for the use of restraints or seclusion. All orders for restraints/seclusion will have the following written elements: Reason for restraints, type of restraint device, maximum duration of order, date and time and physician/LIP signature, nurse documents in the patient's medical record the following ......type of restraint device, ordering physician name, time and date.

ED Staff Registered Nurse (RN # 1) who was assigned to provide Patient #1's care in the ED, was interviewed in person on 11/5/10 at 9:20 AM. RN #1 said Patient #1 would not allow staff to turn him/her on to his/her back and soft restraints were utilized for Patient #1. Patient #1 remained prone and restraints were placed on all four extremities but only the restraints on Patient #1's lower extremities were attached to the stretcher.

Review of Patient #1's 10/23/10 clinical record indicated Patient #1 would not turn on to his/her back to apply the 4 point restraints. However, documentation did not indicate the restraints were ever applied or that an order was written for the application of any type of restraint.

Review of Patient #2's 7/10/10 medical record, indicated an order was written to place Patient #2 in seclusion, for utilization of a physical restraint and a mechanical restraint. The order did not indicate the type of mechanical restraint ordered.

Review of Patient #3's 9/25/10 medical record, indicated Patient #3 was placed in wrist restraints. Review of the restraints and seclusion behavior management care map documentation, indicated a physician signed to identify him/her as authorizing the order, however, the order did not specify the type of restraints ordered or the date and time the order was issued.

Review of Patient #4's 7/8/10 medical record indicated Patient #4 was placed in seclusion and placed in 4 point leather restraints on 7/8/10 at 9:52 PM. Review of restraints and seclusion behavior management care map form documentation, indicated an order was signed, dated and timed to place Patient #4 in seclusion. Documentation did not indicate 4 point restraints were ordered.

Review of Patient #6 8/25/10 medical records indicated the restraints and seclusion behavior management care map, included an order for seclusion, physical restraints and mechanical restraints signed by a physician. However, the order was not dated or timed and the order did not specify the type of mechanical restraints ordered.

Based on documentation review, it was determined the Hospital failed to ensure there were complete physician orders for the application of restraints in 6 (Patients #1, #2, #3, #4, # 6 and #8) out of 11 patient medical records reviewed.

Findings included:


The Hospital policy that addressed restraints of patients was reviewed. The policy stated a written order is required in all cases for the use of restraints or seclusion. All orders for restraints/seclusion will have the following written elements: Reason for restraints, type of restraint device, maximum duration of order, date/time and physician/LIP signature.

The Hospital policy that addressed restraints was reviewed. The policy stated a written order is required in all cases for use of restraints or seclusion.

ED Staff Registered Nurse (RN # 1) who was assigned to provide Patient #1's care in the ED, was interviewed in person on 11/5/10 at 9:20 AM. RN #1 said Patient #1 would not allow staff to turn him/her onto his/her back and soft restraints were utilized for Patient #1. Patient #1 remained prone and restraints were placed on all four extremities, but only the restraints on Patient #1's lower extremities were attached to the stretcher.

Review of Patient #1's 10/23/10 clinical record did not indicate an order for restraints, was written for the application of any type of restraints.

Review of Patient #2's 9/25/10 medical record documentation indicated an order was written to place Patient #2 in seclusion, for utilization of a physical restraint and a mechanical restraint. The order did not indicate the type of mechanical restraint ordered.

Review of Patient #3's 9/25/10 medical record documentation indicated Patient #3 was placed in wrist restraints. Review of the restraints and seclusion, behavior management care map documentation, indicated a physician signed identifying him/her as authorizing the order. However, the order did not specify the type of restraint ordered or the date and time the order was issued.

Review of Patient #4's 7/8/10 medical record indicated Patient #4 was placed in seclusion and place in 4 point leather restraints on 7/8/10 at 9:52 PM. Review of restraints and seclusion, behavior management care map form documentation, indicated an order was signed, dated and timed to place Patient #4 in seclusion. Documentation did not indicate 4 point restraints were ordered.

Review of Patient #6's 8/25/10 medical record indicated the Restraint and seclusion behavior management care map included an order for seclusion, physical and mechanical restraints signed by a physician. However, the order was not dated or timed and the order did not specify the type of mechanical restraints ordered.

Review of Patient #8's 5/9/10 medical record indicated Patient #8 was placed in an unspecified type of mechanical restraint on 5/9/10 at 11:35 PM. Review of the 5/9/10 restraints and seclusion, behavioral management care map, did not indicate the physician/LIP ordering the restraints was identified and a signature, date and time were included to identify when the order was written.