HospitalInspections.org

Based on document review and interview, the hospital failed to ensure restraint orders were time limited and re-ordered following age specific requirements for two (2) of five (5) restraint records reviewed (Records A and B).

Finding includes:

The hospital's policy regarding, "Violent Restraints", mirrors the Federal requirements and stated: "An order must be obtained immediately after application of restraint and/or seclusion, the nurse or other qualified, trained staff obtains an initial order. Re-evaluation and re-order of restraint and/or seclusion must be completed every: - 4-hours for adults, - 2 hours for children and adolescents ages 9-17 ..."

1. On November 13, 2017 at approximately 3:30 PM, a review of Record A was conducted.

The patient was restrained from approximately 2:00 AM until 8:25 AM on September 24, 2017, (a period of 6 hours and 25 minutes).

No practitioner renewal order was located in the patient record timeline, although a renewal order would have been required at 6:00 AM.

2. On November 13, 2017 at approximately 3:45 PM, a review of Record B was conducted.

The patient was restrained from approximately 9:00 PM on September 16, 2017, until 6:05 AM on September 17, 2017, (a period of approximately 9 hours and 5 minutes).

The order written at 9:42 PM, [for the restraint initiated at 9:00 PM], was written using template "Restraints behavioral adult" and was written for a period of 4 hours.

At 3:12 AM a renewal order was written for continuation of restraints, (6 hours 12 minutes after initial restraint order).

The patient was an adolescent and the orders should have been renewed every 2 hours.

Both findings were confirmed with the Clinical Risk Manager at approximately 4:00 PM on November 13, 2017, who verified that the clinical records did not conform with the Federal restraint/seclusion requirements.