HospitalInspections.org

Based on document review and interview, it was determined that for 2 of 2 patient (Pts. #4 and #5) reviewed for violent/behavioral restraint use, the Hospital failed to ensure that each order for the management of violent or self-destructive behavior was renewed every 4 hours for adults as required.

Findings include:

1. The Hospital's policy titled, "Restraint and Seclusion Management" (11/18/2021), was reviewed on 1/12/2022 and required, "...Violent/Self-Destructive Behavior Restraint and/or Seclusion: Order Renewal Frequency Required: Adults 18 years or older: Every 4 hours..."

2. The clinical record of Pt. #4 was reviewed on 1/11/2022. Pt. #4 was admitted on 12/16/2021 with diagnoses of acute psychosis and rhabdomyolysis (breakdown of muscle). Restraint flowsheets and physician's orders indicated the following:
- Pt. #4 was placed in 4-point violent/behavioral restraints from 12/18/2021 at 4:00 AM through 12/19/2021 at 7:30 AM. The record lacked physician's renewal orders for violent/behavioral restraints every 4 hours as required on 12/18/2021 between 4:00 AM and 6:00 PM (missed order renewals due at 8:00 AM, 12:00 PM, and 4:00 PM).
- Pt. #4 was placed in 4-point violent/behavioral restraints from 12/19/2021 at 12:00 PM through 12/21/2021 at 10:00 AM. The record lacked a physician's renewal order for violent/behavioral restraints every 4 hours as required on 12/19/2021 between 12:00 PM and 6:00 PM (missed order renewal due at 4:00 PM) and on 12/20/2021 between 12:15 PM and 6:45 PM (missed order renewal due at 4:15 PM).

3. The clinical record of Pt. #5 was reviewed on 1/12/2022. Pt. #5 was admitted on 12/18/2021 with diagnoses of psychosis and COVID-19 infection. Restraint flowsheets and physician's orders indicated that Pt. #5 was placed in 4-point violent/behavioral restraints from 12/19/2021 at 3:00 AM through 12/21/2021 at 9:00 AM. The record lacked a physician's renewal order for violent/behavioral restraints every 4 hours as required from 12/20/2021 at 5:15 PM to 12/21/2021 at 1:00 AM (missed order renewal at 9:15 PM).

4. An interview was conducted with the Coordinator of Nursing Informatics (E#11) and the Director of Quality/Safety (E#1) on 1/11/2022 during Pt. #4's electronic clinical record review, at approximately 1:42 PM. Both E#11 and E#1 stated that restraint orders for violent/behavioral restraints should be renewed every 4 hours for adults. E#11 confirmed the missing restraint renewals orders in Pt. #4's record. An interview was conducted with E#11 again on 1/12/2022 during the clinical record review for Pt. #5. E#11 stated that based on the flowsheet documentation Pt. #5 was in violent/behavioral restraints from 12/19/2021-12/22/2021 and confirmed the record lacked a renewal order for violent/behavioral restraints between 12/20/2021 at 5:15 PM through 12/21/2021 at 1:00 AM.