HospitalInspections.org

Based on policy and procedure review, job description review, personnel file review, medical record review and staff interviews the hospital failed to ensure security officers participating in application of patient restraints were certified in cardiopulmonary resuscitation (CPR) and first aid in 2 of 2 sampled violent restraint patients (# 18 and #15).

The findings include:

Review on 07/30/2020 of the policy and procedure titled "General Duties and Responsibilities" effective date 10/16/2017 revealed "Protective Services (security officers) provide services for the security of (Named) Healthcare ...and providing information and assistance to patients, visitors, and staff."

Review on 07/29/2020 of the Job Description of a "Security Officer" failed to reveal CPR and First Aid as a job requirement.

Review on 07/30/2020 of the personnel files for four security officers revealed no CPR and First Aid certifications.

1.Review on 07/29/2020 of the closed medical record for Patient #18 revealed a 16-year-old male who presented to the emergency department (ED) via emergency medical services (EMS) for "Combative/Restrained." Review of an ED note dated 07/17/2020 at 2214 revealed "Security at bedside for therapeutic hold, chemical, and violent restraint application." Review of the ED note dated 07/17/2020 at 2223 revealed "...Pt (patient) in 4 point restraints, yelling and combative upon arrival ...Held by arms and legs by security ..." Review of the ED Physician note dated 07/17/2020 at 2210 revealed "Patient was transported fully restrained and required multiple security officers to hold him and restrain him here."

Interview on 07/29/2020 at 1004 with the Manager of Protective Services revealed security officers did participate in the application of restraints by assisting staff with holding of a patient. Interview revealed security officers were not trained in CPR or First Aid as it was not a job requirement.

Interview on 07/29/2020 at 1352 with the Director of Protective Services revealed CPR or First Aid was not a job requirement for the security officers. Interview revealed there was "no denying that" security officers assisted staff with application of patient restraints. Interview revealed the Director of Protective Services was unaware of the regulation that required all staff to be trained in CPR and First Aid if they were participating in application of patient restraints. Interview revealed there were twenty-six security officers and none of them were trained in CPR and First Aid.




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2. Review on 07/28/2020 of the closed medical record for Patient #15 revealed an 8-year-old male who presented to the ED on Involuntary Commitment (IVC) via EMS for "Behavioral Problem" on 09/18/2019. Review of an ED note dated 09/30/2019 at 2032 revealed "Protective Services (Security Officers) and other nurses who are CPI trained, using therapeutic hold to protect staff and the patient from self-harm and harm to other. Hold lasted several minutes while restraints were being placed. The patient continued to kick, bite, spit and curse at staff while restraints were being applied."

Interview on 07/29/2020 at 1505 with RN #3 revealed two to four security officers were present and participated in placing Patient #15 in therapeutic holding during the application of restraints by the ED staff on 09/30/2020. Interview revealed security officers were normally present during restraints in the ED to assist the staff in gaining control of the situation and to ensure patient and staff safety.

Interview on 07/29/2020 at 1352 with the Director of Protective Services revealed CPR or First Aid was not a job requirement for the security officers. Interview revealed there was "no denying that" security officers assisted staff with application of patient restraints. Interview revealed the Director of Protective Services was unaware of the regulation that required all staff to be trained in CPR and First Aid if they were participating in application of patient restraints. Interview revealed there were twenty-six security officers and none of them were trained in CPR and First Aid.

NC00157748 NC00163948