HospitalInspections.org

Based on medical record review, interview and policy review the facility failed to ensure restraint orders were renewed by a physician every 24 hours per hospital policy for 4 out of 6 (# 2, 5, 7, & 8) inpatients currently restrained. Findings include:

On 7/22/13 at approximately 1200 during medical record review on the Surgical Intensive Care Unit 2 (SICU 2), it was documented that patient #2 had been restrained from 7/14/13 to 7/22/13 with one physician order for restraints dated 7/16/13. Further review of the medical record revealed that there were no other physician orders for restraints. During review of the medical record for patient #2 on 7/22/13 at approximately 1200, staff A and E were present and confirmed the findings of a single physician order for 9 days of restraints. When staff E was queried as to if additional orders for restraints were available to be reviewed she replied, "I don't see any other orders."

On 7/22/13 at approximately 1235 during medical record review on the Medical Intensive Care Unit 1 (MICU 1), it was documented that patient #5 had been restrained from 7/18/13 to 7/22/13, with no orders for restraints on the dates of 7/19/13, 7/20/13 and 7/21/13. During review of the medical record for patient #5 on 7/22/13 at approximately 1235, staff A and C were present and confirmed the findings that there was no physician order for restraints for 7/19/13, 7/20/13 and 7/21/13. When staff C was queried as to if additional orders for restraints were available to be reviewed she replied, "I don't know, she came from a different unit, she's had orders since she was transferred to this unit."


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On 7/22/13 at approximately 1245 during medical record review on the Medical Intensive Care Unit 1 (MICU 1), it was documented that patient #7 had been restrained from 7/16/13 to 7/22/13, with no orders for restraints on the dates of 7/16/13, 7/17/13, 7/18/13, and 7/19/13. During review of the medical record for patient #7 on 7/22/13 at approximately 1245, staff A and C were present and confirmed the findings of no orders for restraints on the dates of 7/16/13, 7/17/13, 7/18/13, and 7/19/13. When staff C was queried as to if additional orders for restraints were available to be reviewed she replied, "No, I can't find any more."

On 7/22/13 at approximately 1255 during medical record review on the Medical Intensive Care Unit 1 (MICU 1), it was documented that patient #8 had been restrained from 7/16/13 to 7/22/13, with no orders for restraints on the dates of 7/17/13, 7/18/13, 7/19/13, 7/20/13 and 7/21/13. During review of the medical record for patient #8 on 7/22/13 at approximately 1255, staff A and D were present and confirmed the findings of no orders for restraints on the dates of 7/17/13, 7/18/13, 7/19/13, 7/20/13 and 7/21/13. When staff D was queried as to if additional orders for restraints were available to be reviewed she replied, "Not that I can see."

On 7/22/13 at approximately 1430 during review of policy titled, "Restraint Use for Non-Violent/Non-Self Destructive Behavior in the Non-Psychiatric, Medical/Surgical Health Care Setting", dated 1/22/13, states under Non-Violent/Non-Self Destructive Behavior Orders, #4, "A physician's/MLP designee's order is required to order, change, continue, and discontinue restraint...", and under #5 it states, "A restraint order is good for a maximum of one calendar day (ends at midnight on the day the order is written)."