HospitalInspections.org

Based on review of documents, medical records and staff interview it was determined the facility failed to ensure the use of restraints were in accordance with the order of a physician in two (2) of five (5) medical records reviewed for physician orders (patient #2 and 7). This has the potential to negatively affect all patients by placing them in restraints un-necessarily.

Findings include:

1. Hospital policy titled Patient Restraints, last revised 5/13 states in part: Orders for restraints shall be obtained per restraint episode.

2. Patient #2 had orders for five (5) point restraints for Violent-Self Destructive behavior written at 1212 on 5/10/13. The patient went to the Operating Room (OR) at approximately 1600. When the patient returned to the room at 1940, she was placed back in five (5) point restraints without an order or documentation indicating why.

3. This medical record was reviewed on 2/11/14 at 0855 with the Director of Quality and she agreed with these findings.

4. Patient #7 had orders written for bilateral soft wrist restraints on 11/13/13. Nursing documentation indicated the wrist restraints were placed on 11/13/13. On 11/20/13 nursing documented patient with bilateral wrist and ankle restraints. On 11/25/13 nursing documented bilateral wrist and ankle restraints with all four (4) side rails up. There was no physician orders for bilateral ankle restraints or four (4) side rails found in the medical record.

5. This medical record was reviewed with the Manager of Education and Clinical Practice on 2/12/14 at 1340 and he agreed with these findings.

Based on review of documents, medical records and staff interview it was determined the facility failed to ensure policies were followed in one (1) of five (5) medical records reviewed (patient #2) for attending physician notification when restraints were ordered. This has the potential to negatively affect all patients by restraints being ordered and used unbeknownst to the attending physician.

Findings include:

1. Hospital policy titled Patient Restraint Last reviewed 5/15 states in part: "When the patient is placed into restraints or seclusion for Violent or Self Destructive behavior the physician shall be immediately notified."

2. When the patient became violent, the order for Violent-Self Destructive behavior was written by the Physician Assistant-Certified, without notification of the attending physician documented in the medical record.

3. This record was reviewed on 2/11/14 at 0855 with the Director of Quality and she agreed with these findings.

Based on review of documents, medical records and staff interview, it was determined the facility failed to ensure the order written for Violent or Self Destructive behavior was time limited in one (1) of one (1) medical records reviewed (patient #2) for a time limited order. This has the potential to negatively affect patients in restraints for Violent or Self Destructive behavior by keeping them restrained un-necessarily.

Findings include:

1. Hospital policy titles Patient Restraint, last revised 5/13 states in part: Violent or Self Destructive Restraint Use-Orders shall be time limited. A LIP shall see and evaluate the patient within one hour of initiation of the use of restraints.

2. Review of medical record #2 revealed Violent-Self Destructive restraints were ordered on 5/10/13 at 1212 due to the patient being violent. The order stated bilateral wrist, ankle and vest. This order did not contain a time limit of four (4) hours.

3. This medical record was reviewed with the Director of Quality on 2/11/14 at 0855 and she agreed with these findings.

Based on review of documents, medical records and staff interview it was determined the facility failed to ensure the Physician Assistant-Certified (PA-C) had a working knowledge of hospital policy when ordering restraints in one (1) of one (1) medical records reviewed (patient #2) for Violent-Self Destructive restraints ordered. This has the potential to cause injury to patients who are in restraints for Violent-Self Destructive behavior.

Findings include:

1. Hospital policy titled Patient Restraint, last reviewed 5/13, states in part: Violent or Self Destructive Restraint Use-Orders shall be time limited. A LIP shall see and evaluate the patient within one (1) hour of initiation of the use of restraints.

2. Review of medical record #2 revealed Violent-Self Destructive restraints were ordered on 5/10/13 at 1212 due to the patient being violent. The order stated bilateral wrist, ankle and vest. This order did not contain a time limit of four (4) hours.

3. There was no documentation found in the medical record to indicate the PA-C evaluated the patient one (1) hour after the application of the restraints.

3. This medical record was reviewed with the Director of Quality on 2/11/14 at 0855 and she agreed with these findings.

Based on review of documents, medical records and staff interview it was determined the facility failed to ensure the patient (#2) was seen within one (1) hour after the initiation of restraints for Violent or Self Destructive behavior a LIP in one (1) of one (1) medical records reviewed. This has the potential to jeopardize the immediate physical safety of patients placed in restraints for Violent-Self Destructive behavior.

Findings include:

1. Hospital policy titled Patient Restraint, last revised 5/13, states in part: Violent or Self Destructive Restraints: A LIP shall see and evaluate the patient within one hour of initiation of the use of restraints.

2. Patient #2 was placed in restraints for Violent Self Destructive behavior on 5/10/13 at 1212. There is no documented evidence of an evaluation of the patient.

3. This medical record was reviewed with the Director of Quality on 2/11/14 at 0855 and she agreed with these findings.

Based on review of documents, medical records and staff interview, it was determined the facility failed to ensure the RN supervised and evaluated the nursing care for each patient in one (1) of ten (10) medical records reviewed (#1) relative to the documentation of assessments in restraint use. This has the potential to cause life threatening situations in all restrained patients in their assessments not being completed as per hospital policy.

Findings include:

1. Hospital policy titled Patient Restraints, last revised 5/13 states in part: "The patient in restraints or seclusion for Violent or Self Destructive behavior shall be monitored at least every 15 minutes."

2. Patient #2 was placed in five (5) point restraints ordered as Violent-Self Destructive at approximately 1200 on 5/10/13. Nursing documentation of restraints did not include every fifteen (15) minute assessments.

3. This medical record was reviewed with the Director of Quality at 0855 on 2/11/14 and she agreed with these findings.