HospitalInspections.org

The facility failed to protect and promote the rights of it's patients as evidenced by applying
restraint devices (hand mittens) to 2 patients (#1 and #4) without identifying them as restraints and following proper procedures for patient or reprentative involvement in decision making. See findings at A-0131.

Based on observation, interview and record review, the facility failed to identify, assess, monitor and care plan for the use of restraints in 2 (#1 and #4) of 11 patients sampled. Findings include:

On 5/5/10 at approximately 0915, patients # and #4,were observed lying in their beds.

Patient #1 was calm, resting in bed, and responded appropriately to questions. He had a pair of mitts at the foot of his bed. Nurse #1 stated that she observed the mitts on the patient's hands earlier that morning. On 5/5/10 at approximately 0950, review of the patient #1's medical record revealed a 4/23/10 nursing note stating that mitts were applied because the patient was pulling at the IV line and pulled a dressing off his right neck Quinton Catheter. There were no physician's orders nor care plans for the use of mitts or interventions to address agitated behavior. After the 4/23/10 nursing note, progress notes did not contain documentation of the need for mitts or interventions to monitor their use except for an entry on 4/30/10, noting that the patient was pulling on the mitts. The VP of Patient Services confirmed these findings.

On 5/5/10 at approximately 0900, patient #4 was observed resting in bed with mitts on both hands, secured with Velcro straps. Both mitts were soiled with a dried brown-red substance. On 5/5/10 at approximately 1000, review of the patient's medical record revealed no physician orders nor care plans for the use of mitts or managing agitated behavior. The VP of Patient Services confirmed these findings.

On 5/6/10 at approximately 1100, review of the package insert for the Posey "hand control mitts" described the mitts as "a full pocket mitt without finger separators." Application instructions state:
? "Insert the patient's hand into the mitt, palm down."
? "Wrap the wrist strap around the smallest part of the patient's wrist, through the plastic ring, and secure with the hook and loop fastener."
? "Slide ONE finger (flat) between the device and the inside of the patient's writst to ensure proper fit. The strap must be snug, but not compromise circulation."

On 5/6/10 at approximately 1100 the Vice President of Patient Services confirmed that the facility does not include mitts in their restraint policy. Review of the facility policy titled "Altered Behavior and/or Mental Status, Nursing Care of,(#40.4.216, dated 4/04), mentions the use of Posey mitts under "Emergency Care". Under Documentation, the policy states:

#20. "documentation to include what intervention is attempted and the outcome"
#21. "Skin assessment documented with any use of interventions such as Posey mitts"
#22. "Care plan should reflect interventions initiated. This is to include the reason for the implementation of interventions such as the Posey mitts, repositioning, activity diversion and other interventions attempted."

The VP of Patient Services confirmed that the above documentation listed above was not present in the medical records of patients #1 and #4.