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RAINBOW BABIES AND CHILDRENS HOSPITAL
PATIENT RIGHTS
Tag No.: A0115
Based on record review, interview, policy review and review of the manufacturer's instructions, the faciliy failed to ensure restraints were applied in accordance with manufacturer's instructions. The facility's census was 151.
See A167
PATIENT RIGHTS: RESTRAINT OR SECLUSION
Tag No.: A0167
Based on record review, interview, policy review and review of the manufacturer's instructions, the faciliy failed to ensure restraints were applied in accordance with manufacturer's instructions. This affected one (Patient #1) of ten records reviewed.
Findings include:
Patient #1 was admitted to the facility on 05/06/24 and discharged to jail on 06/14/24.
On 06/08/24 at 8:41 PM, Staff K wrote an order for violent restraints and stated in the comments "above the elbow bilaterally to make 6 point restraints". On 06/12/24 at 7:49 PM, Staff N wrote an order for 6 point restraints.
On 06/09/24 at 2:20 PM, Staff O documented Patient #1 had a code violet overnight requiring intramuscular medications. "He was in 6 point restraints".
On 06/12/24 at 7:00 PM, Staff M documented code violet called and Patient #1 was placed in 6 point restraints.
On 06/12/24 at 7:30 PM, Staff L documented the team decide to place Patient #1 in 6 point restraints. Additional locking restraints were added to Patient #1's upper arms.
During an interview on 08/19/24 at 3:02 PM, Staff B stated staff have not been trained on how to apply 6 point restraints.
During an interview on 08/19/24 at 2:27 PM, Staff B confirmed the manufacturer's package insert for the locked restraints did not include instructions for applying the restraints above the elbow area.
The Posey Twice-As-Tough cuffs - Key Lock Application Instructions revealed to apply the cuffs, wrap the neoprene piece (the blue or red side should be positioned against the skin around the wrist/ankle. It does not state to use above the elbows.
Review of the facility policy titled "Use of Restraints and Seclusion", effective April 2024, stated qualified staff members are those who are trained and able to demonstrate competency in minimizing use of restraints, safe application of restraints, monitoring, and providing care for a patient in restraints. Training takes place as part of orientation and annually thereafter. Of the direct care staff, only registered nurses may perform the assessments necessary of a patient in restraint or seclusion. The training content includes the following:
1. Techniques to identify staff and patient behaviors, events, and environmental factors that may trigger circumstances that require the use of restraints.
2. The use of nonphysical intervention skills.
3. Selecting the least restrictive intervention based on an individualized assessment of the patient's medical, or behavioral status or condition.
4. The safe application and use of all types of restraint used, includes training in how to recognize and respond to signs of physical and psychological distress, and positional asphyxiation.