HospitalInspections.org

Based on events witnessed by the survey team the day of the survey, the hospital staff failed to provide reasonable safeguards to protect the personal privacy of its patients, including the name, medical history, condition, and treatment plan, of persons under the care of hospital medical staff.

The day of the survey, surveyors were present in the main lobby of the hospital. Surveyors witnessed a senior staff physician in the main lobby openly discussing via telephone private personal and health information for two patients in a public location where many bystanders were present to overhear the conversation. The physician articulated the full names of two patients and discussed those patient's detailed medical histories, diagnoses and care plan in a public setting with no regard for those patient's right to personal privacy.

Based on a review of four open and six closed medical records, including three restraint / seclusion records, and hospital policy titled "Restraints and Seclusion" (05/2017) on the date of the survey, it was determined the hospital failed to discontinue violent restraints at the earliest possible time for 2 of 10 patients reviewed.

Patient #1, presented to the Emergency Department (ED) on an Emergency Petition by law enforcement. At 1050hrs, Pt #1 nursing documentation states "patient is unable to be re-directed, refuses to listen to plan of care, continues to scream. Patient assisted to ED via police, security and ED staff - refuses to walk - patient was carried to room and placed immediately into 4-point restraints". At 1120hrs, the physician placed orders for restraints for violent behaviors. At 1150hrs, nursing documentation states "patient screaming and threaten violence to sitter and writer [RN]". Direct observation by the sitter of Pt #1 was documented as the following:

1205hrs: "restless; tearful; quiet; sleeping"
1215hrs: "calm" "quiet"
1230hrs: "sleeping" "restless, quiet"
1255hrs: "sleeping" "quiet"
1300hrs: "sleeping, quiet"

Based on regulation and hospital policy, at 1205hrs Pt #1 was "restless; tearful; quiet; sleeping" and did not exhibit a threat of "imminent harm to self or others" that warranted restraints. Hospital staff failed to remove or discontinue Pt #1's restraints at the earliest possible time.

Patient #7 presented to the ED for acute fatigue and worsening Parkinson's disease. At 0111hrs, the Licensed Independent Provider (LIP) documented "[the patient] has been agitated all night. [Patient] was found to be very agitated, thrashing at nursing, muttering words; Reports of [patient] pulling at Foley catheter" (urinary catheter), "patient was placed in 4 point restraints". At 0111hrs, based on review of the LIP documentation and the hospital policy titled "Restraints and Seclusion", there was no documented description of Pt #7's behavior to justify use of 4-point restraints. Hospital staff failed to discontinue the restraint at the earliest possible time. The direct observation/sitter documented Pt # 7's behavior:

0115hrs: "quiet, confused, calm, cooperative"
0130hrs: "quiet, confused, calm, cooperative"

Pt #7 remained in restraints and at 0427hrs, the LIP renewed the restraints order for Pt #7 and documented only "danger to others" as indication to continue the restraints. There was no detailed documentation of Pt #7's behavior to justify the continued use of restraints in the patient record.

At 0753hrs, again the LIP renewed the restraint order for Pt #7, and documented only "danger to others" as reason to keep the patient restrained with no specific description of behavior(s) that warranted the use of Violent Restraints. The sitter documentation for the following four hours, at 0800hrs and at every fifteen minute interval until 1200hrs, Pt #7 visual check as:
"Agitated; restless" and behavior as "appropriate". Yet Patient #7 remained in 4-point restraints. Hospital staff failed to discontinue the restraint episode at the earliest possible time. No behavioral description to justify continuation of the restraints was found in Pt#7's medical record.

Based on a review of four open and six closed medical records, including three restraint / seclusion records, it was determined that the hospital medical staff failed to document evidence of a Face-to-Face evaluation on 3 of 10 patients. No documentation was found in the medical records of the four criteria of a Face-to-Face evaluation by a physician or LIP within one hour of the initiation of the initiation of restraints for Patient #1, Patient #6 and Patient #7.

Patient #1, presented to the Emergency Department (ED) on an Emergency Petition by law enforcement. At 1050hrs, Pt #1 nursing documentation states, "patient placed immediately into 4-point restraints". At 1120hrs, the physician placed orders for Violent Restraints. No evidence or documentation was found in the medical record the attending physician or LIP conducted a Face-to-Face evaluation on Pt# 1 within one hour of initiation of restraint.

Patient #6 was brought to the ED with altered mental status and UTI. At 0400hrs on day two, an initial order for restraints was placed by an LIP and no specific behavior(s) documented to justify the use of restraints. No evidence or documentation was found in the medical record the attending physician or LIP conducted a Face-to-Face evaluation on Pt# 6 within one hour of initiation of Violent Restraint. At 1415hrs, order for Violent Restraints was placed by an LIP and no specific behavior(s) documented to justify the use of restraints. No evidence or documentation was found in Pt #6's medical record that the attending physician or LIP conducted a Face-to-Face evaluation within one hour of initiation of restraints.

On day five, at 0300hrs, an LIP ordered restraints for Pt #6 with no specific description of behavior(s) documented by the LIP to justify the use of restraints. No evidence or documentation was found in Pt #6's medical record that the attending physician or LIP conducted a Face-to-Face evaluation within one hour of initiation of restraints.

Patient #7 presented to the ED for acute fatigue and worsening Parkinson's disease. At 0111hrs, the LIP documented "patient was placed in 4 point restraints and administered 2mg Ativan, [and] 2mg Haldol IM (intramuscular)". No evidence or documentation was found in Pt #7's medical record that the attending physician or LIP conducted a Face-to-Face evaluation within one hour of initiation of restraints.

Based on the review of patient #8's medical record, it was determined that there was no medical assessment or evaluation for post- operative day one documented.

Patient #8's record was, reviewed on post-operative day two, without physician or mid-level provider documentation for post-operative day one and the current day post-operative day two. Open record review included: history and physical, operative notes, general consent, surgical consent, nursing notes, social work/ case management notes, physician and mid- level notes. Record review for post -operative day one lacked documentation from a physician or mid-level provider of the patient. The facility was unable to provide documentation during survey of provider documentation for post-operative day one.