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Based on hospital policy review, medical record review, staff interviews, and email correspondence, hospital staff failed to ensure application of soft wrist restraints were accompanied by a physician order in a timely manner for 2 of 4 medical records reviewed (Patients #11, #12).

The findings include:

Review of hospital policy on 08/21/2018 titled "Restraints," with revision date of August 2016, revealed "...D. In an emergency situation, a RN trained in the application of restraints may place the patient in restraints and/or seclusion prior to receiving an order from the Licensed Practitioner caring for the patient. Once the patient has been placed in restraints and/or seclusion, the practitioner must be notified and an order received immediately (this may occur via telephone if the practitioner is not immediately available to be present AND the patient is restrained for NON-violent/NON-self-destructive behavior)...."

1. Closed medical record review on 08/22/2018 revealed a 65 year old male (Patient #11) admitted on 08/04/2018 at 0413 from a nursing home for GT malfunction (Gastrostomy tube-feeding tube surgically placed in stomach). Review of restraint documentation revealed restraints were applied at 1400 on 08/04/2018. Review of the physician's order for restraints revealed the order was entered at 1934 on 08/04/2018, 5 hours and 34 minutes after restraints were applied.

Interview on 08/23/2018 at 1035 with Patient #11's assigned nurse (LPN #1) revealed wrist restraints were on when shift started. "Day shift nurses called and got the order." Interview revealed no reason restraint order was not obtained in a timely manner.

The ordering physician was not available for interview.

Interview on 08/23/2018 at 0930 with Quality Director #1 revealed an initial order was not written in the medical record timely and the policy was not followed.

2. Closed medical record review on 08/23/2018 revealed a 56 year old male (Patient #12) admitted for pancreatitis. Review of restraint documentation revealed left and right wrist restraints were applied on 07/04/2018 at 0200. Review of physician's order for restraints revealed the order was entered at 0648 on 07/04/2018, 4 hours and 48 minutes after restraints were applied.

Interview on 08/23/2018 at 1045 with the ordering physician (MD #2) revealed routine orders are written in the morning after early morning rounds. Further interview revealed physicians are available around the clock and can be called for any need.

The RN who applied the restraints was not available.

Interview on 08/23/2018 at 0930 with Quality Director #1 revealed an initial order was not written in the chart timely and the policy was not followed.

NC00141702