HospitalInspections.org

Based on review of facility policy, review of a personnel file, medical record review, and interviews, the facility failed to use appropriate nursing interventions for 1 restrained and confused Surgical Intensive Care Unit (SICU) patient (Patient #1) of 3 SICU patients reviewed.

The findings included:

Review of the facility's policy titled "Plan for the Provision of Care 2020 - 2021," dated 10/27/2020, revealed "...Practice of professional nursing means the performance of those acts requiring substantial specialized knowledge, judgement, and nursing skill based upon applied principles of psychological, biological, physical, and social science...observation, assessment...maintenance of health and prevention of illness...the professional nurse and practical nurse shall be responsible and accountable for making decisions that are based upon the individual's educational preparations and experience in nursing..."

Review of the facility's policy titled "Restraint and Seclusion Policy," dated 6/3/2021, revealed "...Restraint: any physical or mechanical device, material, medication, or equipment that immobilizes or reduces the ability of a patient to move his arms, legs, body, or head freely...protect the patient and preserve the patient's rights, dignity, and well-being during restraint use...maintaining...safe environment...all staff...will receive education and training in the proper and safe use of...restraint application and alternative methods of handling behavior...our facility educates and assesses the competence of staff...prior to participation in any use of restraint...as part of orientation and on a periodic basis..."

Review of Registered Nurse #5's (RN) personnel file revealed the nurse was hired on 4/8/2019. Further review showed during RN #5's clinical orientation on 4/9/2019, she received training on restraints and completed the associated competency on 4/30/2019. The training included review of the facility's restraint policy, a training module on restraints, and participation in a Clinical Skills Fair.

Medical record review showed Patient #1 was admitted to the facility on 1/15/2021 with diagnoses including Acute Respiratory Failure with Hypoxia (decreased oxygen in tissues to maintain adequate bodily functions) and
Hypercapnia (increased carbon dioxide blood levels due to inadequate respiration), Urinary Tract Infection, Chronic Obstructive Pulmonary Disease (COPD), Pneumonia, and Type 2 Diabetes Mellitus.

Medical record review revealed Patient #1 was placed in soft, bilateral wrist restraints on 1/15/2021 after he was placed on a ventilator to prevent the patient from removing the ventilator tube. On 1/22/2021 the restraints were removed from the patient after the ventilator was discontinued and the patient was placed on oxygen (O2) via nasal cannula (tubing placed in the nostrils to deliver O2). On 1/28/2021 at 9:00 AM the bilateral wrist restraints were again placed on Patient #1's due to his agitation and his attempts to grab his supplemental feeding tube and to remove his O2. The patient was noted to be oriented to his name, but not to place, situation, or time.

Medical record review of a History and Physical for Patient #1 dated 1/16/2021 revealed "...no safety awareness...unable to follow safe instructions..."

Review of RN 5's personnel file revealed a written statement from RN #1 regarding an incident that occurred on 1/29/2021 involving RN #5 and Patient #1. RN #1 wrote that she observed Patient #1 in bilateral wrist restraints and noted the patient was receiving O2 via nasal cannula and his O2 saturation was 87-88 percent (%) (normal oxygen saturation 92 -100 %). RN #1 wrote "...she [RN #5] walked into the patients [Patient #1] room and placed a hospital blanket over the patients face including his nose and mouth..." Further review showed RN #5 informed RN #1she had done that throughout the night to increase the patient's O2 saturation. RN #1 removed the blanket and notified the charge nurse of the Surgical Intensive Care Unit (SICU) of the incident.

During a telephone interview conducted on 8/23/2021 at 10:50 AM, the Assistant Chief Nursing Officer (ACNO) stated while Patient #1 was in wrist restraints, RN #5 placed a blanket over his head which he was unable to remove. The ACNO stated "...this was a restriction of patient rights..."

During a telephone interview on 8/23/2021 at 12:40 PM, the SICU Nursing Director stated when she asked RN #5 about the incident, she did not deny it. RN #5 stated Patient #1 breathed better and his O2 saturation improved after she placed the blanket on his head.

During a telephone interview on 8/23/2021 at 4:00 PM, the Chief Nursing Officer (CNO) stated the use of a blanket over a restrained patient's face was not what she would have expected from a RN on how to treat a patient and "...that was clearly not a nursing intervention to care for a patient...placing a blanket over the patient's face...no, nurses are not taught to put blankets over patients' faces..."

During an interview on 8/23/2021 at 4:10 PM, the RN Clinical Educator stated she trained newly hired Nurses to the facility and the training included restraint use, including the restraint type and alternatives to restraint use. The Clinical Educator stated "...no, I have never taught licensed staff to place a blanket over a restrained patient's face..."

During a telephone interview on 8/24/2021 at 10:30 AM to 11:04 AM RN #5 stated she received adequate training to perform her RN duties, including the proper use of restraints. She stated Patient #1 was confused and would remove his oxygen causing his O2 saturation to decrease. RN #5 further stated "...I wanted him [Patient #1] to relax...I folded a blanket around his head to his shoulders...a small piece of blanket had fallen over his face...he said he was fine..." RN #5 stated Patient #1 complained of being cold, so she placed a blanket around his head. The nurse confirmed the patient had bilateral wrist restraints throughout her 7:00 PM - 7:00 AM shift on 1/28/2021. RN #5 confirmed she was not trained to place a blanket over a restrained patient's face, and she did not remove the blanket when she observed the blanket had fallen over his face "...no, he was cold...he was sleeping well..."