HospitalInspections.org

Based on findings from medical record (MR) review, facility document review and interview, in 1 of 1 emergency department (ED) MR reviewed regarding restraint use (Patient A), documentation describing use of a restraint intervention was lacking.

Findings include:

--Per MR review, Patient A arrived at the ED with police on 5/29/14 at 2:19 pm with diagnosis of alcohol intoxication.

Although the MR contains a physician order written for a restraint at 3:18 pm, it lacks documentation indicating if the patient was actually restrained and why.

--Per review of a Security Department Crisis Intervention Report (CIR) dated and timed 5/29/14 at 3:00 pm, Patient A was being verbally assaultive towards staff during the ED visit and attempting to elope. He was restrained by his arms and returned to his room. Patient A was released from restraint and his shoes removed. The CIR is not part of the MR.

--These findings were acknowledged by the Director of Quality Management on 7/30/14 at 2:35 pm.

Based on findings from facility document review and interview, in 2 of 2 security staff personnel files reviewed the facility failed to ensure that security staff who might be involved in the restraint of a patient received training in the use of first aid techniques.

Findings include:

--Per review of personnel files for 2 security staff (Staff #1 and Staff #2), both lacked documentation of first aid training.

--Per interview on 7/30/14 at 2:50 pm with the Lead Supervisor for Security, security staff do apply restraints to patients but are only trained in cardiopulmonary resuscitation, they are not also trained in first aid techniques.

Based on findings from medical record (MR) review and interview, when it became apparent there may have been a misinterpretation the facility did not retrospectively verify the accuracy of interpretation of Patient A's left arm x-ray obtained during an emergency department (ED) visit. Specifically, the xray film of this patient who complained of arm pain during an ED visit and was found during that visit to not have injury, was not re-reviewed when he re-presented to the ED one day later with evidence a suspect fracture had been diagnosed at another hospital (Hospital #2).

Findings include:

--Per review of Patient A's MRs, he was brought to the ED at this hospital on 5/29/14 at 2:10 pm and 8:10 pm. He also was brought to the ED again on 5/30/14 at 4:10 pm. For each visit the patient was brought by police due to acute alcohol intoxication.

During the 5/29/14 2:10 pm ED visit the patient complained of left arm pain. An x-ray obtained during the visit was interpreted as "no joint effusion and no acute injury." Patient A was discharged at 6:29 pm.

Patient A was brought to the ED again that same day at 8:10 pm with diagnosis of alcohol intoxication. The MR does not describe any complaints of left arm pain and indicates the patient exhibited normal ROM (range of motion) of extremities. Patient was discharged from the ED at 4:10 am on 5/30/14.

The patient was brought to the ED later that day (still 5/30/14) at 4:07 pm with alcohol intoxication. He had a fiberglass splint on his arm. The ED provider was able to electronically review an x-ray report from the patient's visit at Hospital #2 where the splint had been applied. It indicated the patient had a suspected non displaced left radial head fracture with joint effusion.

--Per interview with the Director of Quality Management (DQM) on 10/28/14 at 2:30 pm, the facility did not retrospectively review Patient A's 5/29/14 left arm x-ray to verify its accuracy when he presented with evidence of subsequent diagnosis of possible arm injury and/or when a complainant later expressed concerns to the hospital that the patient's arm was fractured during the 5/29/14 2:10 pm ED visit.

--Following the interview above, the hospital completed a re-review of the xray from the 5/29/14 2:10 pm ED visit at this hospital.

--Per follow up interview with the DQM on 10/28/14 at 2:40 pm, the re-review identified a corrected finding of small fracture of left medial head condyle.