HospitalInspections.org

Based on document review and interview, in six (6) of 22 medical records reviewed, it was determined the facility failed to meet the Condition of Participation for Patient Rights. Specifically, the facility failed to provide patient care in an environment that ensures safety and protection of all patients as evidenced by:

(a) The facility staff failed to recognize the use of manual hold as a form of physical restraint,

(b) Ensure security officers, who are called to assist and manage disruptive patients, receive training in the use of nonphysical intervention skills, and the training is kept current,

(c) ensure that the security officers, who assist with restraints and perform manual holds, are trained in the use of first aid techniques, and certified in the use of cardiopulmonary resuscitation (CPR), including periodic recertification. (Patient #s 1 through 6)

These failures may have placed patients at risk for harm.

Findings include:

During interviews with Security Officers, Staff A, B, C, D, and E on 5/22/17 from 12:00 PM through 2:40 PM, staff reported that they conduct manual hold and assist clinical staff in restraint application but do not apply restraints.

The hospital staff did not recognized the use of manual hold as a form of restraint.

See Tag 159.


Review of ten personnel files for Security Officers, Staff A through J identified that these staff members have no training in the use of nonphysical intervention skills.

The use of untrained staff to perform manual hold on patients and assist clinical staff in the application of restraints places patients at risk for harm.

See Tag 200.

Review of ten personnel files for Security Officers, Staff A through J identified that these staff members have no training in use of first aid techniques, and are not certified in cardiopulmonary resuscitation as required for staff who assist clinical staff in restraint application.

See Tag 206.

During interview with Staff A, Security Officer Manager on 5/22/17 at 12:46 PM, Staff A acknowledged that Security Officers have no training in nonphysical intervention skills, use of first aid techniques, and are not certified in the use of cardiopulmonary resuscitation.

Based on document review and staff interview, facility staff failed to recognize the use of manual hold as a form of physical restraint.

Findings include:

Review of six (6) security incident reports titled "Security Department Restraint/Medical Hold Down Patient Forms" revealed that security officers applied manual hold during restraint management of disruptive patients.

During interview with Staff B, Security Officer on 5/22/17 at 12:55 PM, Staff B stated that security officers apply manual hold during restraints application but do not apply restraints. Staff B stated that manual hold is not a restraint.

During interview with Staff C Security Officer on 5/22/17 at 2:22 PM, Staff C explained that he applies manual hold as directed by the clinical staff during restraint application but does not apply physical restraint.

Security Officers, Staff E and D provided similar report on interview on 5/22/17 at 2:40 PM, they stated that they apply manual hold but do not apply physical restraints.

Staff A, Security Officer Manager was interviewed on 5/22/17 at 12:46 PM. Staff A acknowledged that Security Officers do not consider manual hold as a physical restraint.

The facility's policy on "Restraints," effective date January 2017 defined Restraints as "any manual method, physical or mechanical device, material or equipment that immobilizes or reduces the ability of the patient to move his or her arms, legs, body, or head freely.

Security officers failed to recognize the use of manual hold as a form of restraint as per the facility's policy on "Restraints".

Based document review and staff interview, in 10 of 10 personnel files reviewed, it was determined that the facility failed to ensure that security officers who are called to assist in the management of disruptive patients, received training in the use of nonphysical intervention skills (Staff A through Staff J).

Findings include:

Review of six (6) security reports titled "Security Department Restraint/Medical Hold Down Patient Forms" revealed that security officers applied manual hold during restraint management of disruptive patients.

Security report on 4/18/17 at 2:21 PM documented that security officers assisted licensed personnel in the application of a four-point restraint to Patient #2, as requested by the physician in the Emergency Department.

Similar findings were identified in medical records for Patient #3, #4, #5, and #6, where security officers assisted in the application of restraints with the use of manual hold.

During interviews with Security Officers, Staff B, C, D, and E on 5/22/17 at 2:40 PM, these staff acknowledged that they did not receive training on nonphysical intervention skills/de-escalation techniques to manage disruptive patients.

Review of ten personnel files for Security Officers, Staff A through J identified that these staff members have not received training on nonphysical intervention skills/de-escalation techniques for the safe management of disruptive patients.

During interview with Staff A, Security Officer Manager on 5/22/17 at 12:46 PM, Staff A, Security Manager acknowledged that Security Officers have no training on nonphysical intervention skills/de-escalation techniques.

Based on document review and interview, in 10 of 10 personnel files reviewed, the facility failed to ensure that the security officers, who assist with restraints and perform manual holds, are trained in the use of first aid techniques, and certified in the use of cardiopulmonary resuscitation (CPR), including periodic recertification (Staff A through Staff J).

Findings include:

Review of six (6) security reports titled "Security Department Restraint/Medical Hold Down Patient Forms" revealed that security officers applied manual hold during restraint management of disruptive patients.

Security report on 4/29/17 at 6:00 PM documented that security officers assisted licensed personnel in the application of a two-point restraint to Patient #1 as requested by clinical personnel.

Security report on 4/18/17 at 2:21 PM documented that security officers assisted licensed personnel in the application of a four-point restraint to Patient #2, as requested by the physician in the Emergency Department.

Similar findings were identified in medical records for Patient #3, #4, #5, and #6, where security officers assisted in the application of restraints with the use of manual hold.

During interviews with Staff B, C, D, and E Security Officers on 5/22/17 at 2:40 PM, these staff stated that they are not trained in the use of first aid techniques, and are certified in cardiopulmonary resuscitation.

Review of ten personnel files for Security Officers, Staff A through J identified that these staff members have not received training in the use of first aid techniques, and are not certified in the use of cardiopulmonary resuscitation.

During interview with Staff A, Security Officer Manager on 5/22/17 at 12:46 PM, Staff A, Security Officer Manager acknowledged findings.