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Based on record review and interview, the governing body failed to ensure that the services provided under contract in the hospital utilized policies which were approved by the governing body. This deficient practice is evidenced by the contracted security provider using pepper gel on 1 (#5) out of 5 (#1-#5) patients sampled.
Findings:

Review of the contract for Contractor Service Provider A revealed a current contract to provide security professional services for Hospital A.

Review of the policy statement for Contractor Service Provider A, titled Legal -Use of Force and Reporting policy, revealed in part, It is Contractor Service Provider A's policy that employees shall not use physical force against persons unless the employee reasonably believes that such force to be necessary to protect the employee or another individual from imminent bodily harm.

Review of Patient #5's medical record revealed on 01/18/2022 Patient #5 became combative with the staff in the ED and the ED security guard sprayed pepper gel on the patient.

An interview was conducted with S8Facility Director on 03/15/2022 at 8:30 a.m. S8Facility Director reported Contractor Service Provider A is contracted to provide security for the hospital. He further reported the policy of the Contractor Service Provider A for use of force has not been approved by the Governing Body of the hospital.

Based on record review and interview, the RN failed to implement an appropriate method of restraint. The deficient practice is evidenced by the RN utilizing her foot to brace the patient's head in a turned position to prevent the patient from harming self and staff for 1 (#2) of 5 (#1-#5) patients sampled. Findings:


Review of the hospital's policy, Emergency Use of Restraints for Violent/Self -Destructive Behavior (in Acute Setting) revealed in part, When restraints are necessary, Hospital A is committed to the appropriate use of restraints as a mechanism to support and protect patients from injury to self and others.

Review of a self-report of allegation of abuse/neglect against Patient #2 on 1/14/2022 revealed in part, during a violent episode of the alleged patient while under a PEC, it is alleged by S7Security Guard that an emergency nurse kicked the patient in the head 3 times. With further review of the self- report revealed a statement from S3RN. The statement revealed in part, after calling Police Department A back to ER for the second time after the patient eloped in an attempt to get him back into restraints it took several police officers and nurses to get him into leather restraints (after he had already broken a pair). After restraining the patient he continued to throw himself around in the bed, hit the back of his head on the wall behind him in bed, and then began eating and biting the restraint on his right wrist. He was tearing chunks out of it. His mouth was bleeding I assume from the glass he was eating earlier in the night and from tearing the restraints, or from when he was hitting his face on the wall. In an attempt to get him to stop tearing the restraints with his teeth and to keep him from biting my hand like he had bitten everything else he could get close enough to I put my foot on his forehead to hold his face away for his wrist and push it up so he would stop tearing it and getting out the restraint. I would have done the exact same thing with my hand if he hadn't been biting everything he could. I in no way did it violently or aggressively, only to stop him from tearing the restraints.

An interview was conducted with S4RN on 03/15/2022 at 7:05 a.m. S4RN reported on 01/14/2022 Patient #2 was assigned to his care. S4RN further reported he was assisting with placing the patient in restraints at the time of the allegation of S3RN kicking Patient #2. He reported S3RN did not kick the patient, S3RN was holding the patient's head with her foot to keep Patient #2 from biting the wrist restraint. S4RN also reported the stretcher was in the lowest position to the floor when this incident occurred.

An interview was conducted with S5RN on 03/15/2022 at 7:25 a.m. S5RN reported she was the charge nurse in the ED at the time of the incident. S5RN also reported she was assisting with restraining the patient along with S3RN, S4RN, and numerous police officers from Police Department A. S5RN reported they were attempting to restrain Patient #2 in order to administer medication. S5RN further reported S3RN put her foot on the patient's head to push away the patient' head to further prevent the patient from eating the plastic on the restraint. Patient #3 was spitting out the plastic from the restraint as they were attempting to restrain him.

An interview was conducted with S6EDMger on 03/15/2022 at 10:12 a.m. S6EDMger reported Patient #2 was strong, violent and was biting anything close to his mouth. S6EDMger further reported it is not the preferred choice to assist with restraining patient with a foot on the head, but it is better to bite a shoe than a hand. S6EDMger further reported as a nurse leader he would not use a foot to assist with restraining a patient's head to prevent him from biting.