HospitalInspections.org

Based on interview and record review the facility failed to implement further training for staff for 1 of 5 patient restraint records reviewed (Patient #1).

Failure to provide further education and training for the use of restraints that may include the use of chemical and/or physical restraints puts patients at risk for physical and/or emotional harm.

Reference: Code of Federal Regulations
42.482.13.f.1.i-iii: "Standard: Restraint or
seclusion: Staff training requirements. The patient
has the right to safe implementation of restraint or
seclusion by trained staff.
(1) Training intervals. Staff must be trained and
able to demonstrate competency in the
application of restraints, implementation of
seclusion, monitoring, assessment, and providing
care for a patient in restraint or seclusion-
(i) Before performing any of the actions specified
in this paragraph;
(ii) As part of orientation; and
(iii) Subsequently on a periodic basis consistent
with hospital policy.

Findings included:

1. Review of the hospital's policy titled "Restraint and Seclusion", revised 01/18 showed that patients were to have the most least restrictive form of restraints used to protect the patient from causing harm to themself and/or others.

2. Review of Patient #1's record revealed the patient was admitted to the hospital after a violent outburst in their community care setting. The patient was admitted to the hospital from 11/24/18 until 01/31/19. There was a 24-hour period of time on 12/09/18 to 12/10/18 when the patient was in 4-point restraints. Nursing documentation during this same time period showed that the patient was drowsy and hard to awaken.

3. On 03/18/19 at 10:00 AM, Staff #1 was interviewed. Staff #1 a licensed nurse, stated that the hospital had received a prior complaint about the care and use of chemical and physical restraints on Patient #1 The hospital had identified training gaps and determined that staff needed more training on the use of restraints both chemical and physical restraints. The addtional training had not been implemented since the admission of Patient #1. The last training involving restraints was done in October 2018.

4. On 03/18/19 at 1:30 PM, Staff #2 was interviewed. Staff #2 stated a root cause analysis had identified gaps in training for both physicians and nursing staff for the use restraints. The hospital was looking at increasing staff training for restraints both chemical and physical restraints.

5. On 03/13/19 at 2:00 PM, Staff # 3 was interviewed. Staff #3, a licensed nurse verified the above information.