HospitalInspections.org

Based on document reviews and staff interviews the facility failed to provide written notification to complainants regarding the outcome of the grievance investigations for five (5) out of six (6) complaints reviewed.

Findings:


On 6-7-11 at 11:00 AM, review of complaint investigations received during 2011 revealed that the facility did not provide written notification to the complainant after completing the investigations in five (5) out of six (6) complaints reviewed.

Review of the hospital policy titled " Patient Rights: Complaints " dated 2009, revealed that " the designated individual from administration [will] provide feedback on the out come of an investigation to the patient or family " but does not include a requirement for a written notification.

Interviews with staff members # 2 and # 4, during the afternoon of 6-7-11, revealed that the facility became aware of the requirement for written notification to complainants in April 2011, but has not implemented a revision to the complaint process and does not currently provide a written response.
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Based on staff interviews and record reviews in four (4) out of seven (7) medical records for patients that required restraints, it was determined that the Physician Order Forms for Restraint/Seclusion were incomplete and did not include all required physician documentation in accordance with the hospital policy. (Patients # 19, #21, #22 and #23)

Findings:

The physician did not authenticate an order for a 4 point restraint applied to Patient #22 on 01/07/11 at 9:05 PM, the physician signature, date and time was missing.

The physician did not date and time the restraint order for Patient #19 on 12/31/10 at 5:30 PM .

The physicians did not document the indications for ordering restraint for Patient #21 on 11/06/10 at 2:25 PM and 12/12/10 at 9:00 PM or for Patient #23 on 02/11/11 at 12:20 PM.

The physician did not document the maximum duration of time allowed in restraint for Patient # 21 on 11/06/10 at 2:25 PM.

The physician failed to document the reason for the delayed arrival (greater then 30 minutes) as required by the hospital's policy for Patient
#22 who was placed in 4 point restraint on 01/11/11 at 5:30 PM and was released at 6:15 PM. The physician did not evaluate the patient until 01/13/11 at 9:30 AM.

The physician did not sign, date or time the treatment note for Patient # 19 who was placed in restraint on 12/28/10 at 8:59 PM.

The physician order form for the treatment update plan was left blank for Patient # 21 who was placed in 4 point restraint on 12/12/10 at 8:40 PM and for patient # 23 who was restrained in 5 point restraint on 02/11/11 at 12:30 PM.

Review of the policy titled " Patient Care: Restraint and Seclusion " dated 02/2008 states in Section - 2 : Initiation of Seclusion or Restraint "
that the use of physical restraints requires an MD written order and includes date, time, type, duration and indication, criteria for release and except in an emergency a physician must examine the patient prior to ordering this intervention." Section - 4: Emergency Use of Seclusion or Restraint documents that "in an emergency when a patient is engaging in activity that presents an immediate danger an RN may direct the restraint of the patient and notify the physician, who must see the patient in 30 minutes."

These findings were verified onsite with Administration Staff during the Allegation Survey.
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Based on record reviews and staff interviews there was no documented evidence that the restrained patient's vital signs were evaluated immediately after application or were assessed upon release of the restraints/seclusion in four (4) of seven (7) medical records reviewed. (Patients #22, #23, #20, #18).

Findings:

Medical Record review for Patient #22 revealed a 14 year old female housed in the Adolescent Unit required physical restraints and seclusion periodically for aggressive and combative behavior. The Restraint/Seclusion Order Form dated 01/03/11 at 5:15PM documented a physician ' s order for four (4) point restraint. There was no documented evidence that the patient's vital signs were obtained when the patient was placed in restraints or upon release of the restraints at 6:15 PM as per hospital policy. The patient was again placed in 4 point restrained on 01/11/11 with no documented evidence of vital signs being taken at 5:30 PM or upon release at 6:15 PM. On 01/13/11 at 3:25 PM, the patient required a physician order for a manual hold to administer an intramuscular injection with no documented evidence her vital signs were monitored. The patient was then placed in seclusion on 01/18/11 at 6:25 PM and the vital signs section of the Restraint Assessment Flow Sheet was blank.

Medical record review for Patient #23 revealed a 17 year old male housed in the Adolescent Unit who required physical restraints and seclusion periodically for agitated and threatening behavior. The Restraint Assessment Flow Sheet dated 02/11/11 was blank for vital signs at 1:20 PM after one hour in a 5 point restraint. The patient was again placed in 5 point restraint on 02/21/11 at 4:40 PM, with no documented evidence of vital signs being taken the time of application or upon release at 5:30 PM.

Medical record review for Patient #18 revealed a 12 year old female placed in a five (5) point restraint on 01/09/11 at 9:05 AM following an altercation with a peer. The patient was released from restraints at 10:05 AM, after sixty (60) minutes. The Restraint Assessment Flow Sheet was blank for the vital signs section at the time of application and the time of release from restraints.

Medical record review for Patient #20 revealed an 11 year old female placed into seclusion on 12/14/10 at 9:28 AM with agitation and physical aggression. The vital signs section of the Restraint/Seclusion Assessment Flow Sheet was blank at 9:28 AM and 10:28 AM.

The policy titled " Patient Care: Restraint and Seclusion " dated 02/2008 states in Section 5 : Monitoring Patients in Seclusion or Restraint - in order to assess the patient ' s physical status during the use of restraints or seclusion, vital signs consisting of blood pressure, temperature, pulse, respirations, skin color, appearance of nail beds shall be taken and recorded on the restraint and seclusion monitoring form. For patients in restraint / seclusion, vital signs should be taken immediately after application of restraints, and every hour thereafter and upon release, or more frequently as ordered by the physician.

These findings were verified with Administration Staff on 06/07/11 at 12:15 PM.
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Based on record reviews and staff interviews there was no documented evidence of Cardiopulmonary Resuscitation (CPR) Certification in five (5) out of eight (8) personnel files reviewed for staff members who apply, monitor and provide care to patients in restraints as required by the hospital policy.

Finding:

Review of the Psychiatric Aides (PA) personnel files on 6-7-11 revealed 4 out of 5 PA ' s had no documented evidence of CPR Certification.

Review of the Registered Nurses (RN) files revealed 1 out of 3 RN ' s lacked documentation of CPR Certification.

Review of the facilities policy titled " Care of Patient: Restraint and Seclusion in Behavioral Health " dated 2008, Section XI. Staff Training and Competency documents training of direct care staff includes (g) first aide and CPR certification.

Review of the job description for Psychiatric Aides documents under Duties and Responsibilities: Item #14. Responds to inappropriate patient behavior as directed by the RN including the application of restraints / seclusion in a safe and effective manner.

Interviews with staff members # 2 and # 4, during the afternoon of 6-7-11, revealed that the CPR training was provided only to the full time PA ' s working the night shift and was not provided to all the direct care staff.
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