HospitalInspections.org

Based on interview, policy and record review, the facility failed to ensure that 1 of 1 Emergency Department patients (patient #2) was physically restrained according to facility policies. Findings include:

1. From 12/26/12-12/27/12 review of patient #2's clinical record revealed that on 8/22/12 at 8:19 pm, the patient was physically restrained when attempting to leave the Emergency Department during a mental status assessment. Patient #2 was reported to be: "..... shouting at staff" and "...... tried to push a Tech."
2. Patient #2's clinical record for 8/22/12 revealed physician orders at 8:24 pm for, "4 point hard restraints" and at 8:25 pm for restraint application category, "Non-violent Non-Self-destructive-every 2-hour check" the rationale for which included, ".... risk of harm to others, risk of harm to self."
3. On 8/23/12 at 2:23 am the Emergency Department Charge Nurse documented that the patient was released from restraints.
4. The patient's record did not contain a one-hour physician evaluation as required by facility policy, "Restraint and Seclusion, EHR010" which states that when restraints are applied for violent or self-destructive behavior restraints must be ordered/re-ordered for: "A maximum of every 4 hours for adults 18 years and older."
5. On 12/27/12 at approximately 3:30 pm the Emergency Department (ED) Administrator stated that patient #'2's episode of restraint on 8/22/12 should have been ordered for violent, not "non-violent" behavior, and been subject to the order/re-order requirements noted in hospital policy EHR010. The ED Administrator also verified that the patient's record did not contain evidence of physical restraints being reordered by a physician within 4 hours of application, although restraint continued.

Based on interview, policy and record review, the facility to ensure that 1 of 1 Emergency Department patients (#2) was provided with a physician/physician assistant assessment within 1 hour of restraint application, per policies. Findings include:

1. From 12/26/12-12/27/12 review of patient #2's clinical record revealed that on 8/22/12 at 8:19 pm the patient was physically restrained when attempting to leave the Emergency Department during a mental status assessment. It was noted that the patient was "shouting at staff" and "tried to push a Tech."
2. The patient's record for 8/22/12 revealed physician orders at 8:24 pm for "4 point hard restraints" and at 8:25 pm for "restraint application category "Non-violent Non-Self-destructive-every 2-hour check" for "risk of harm to others, risk of harm to self."
3. On 8/23/12 at 2:23 am the Emergency Department Charge Nurse documented that the patient was released from restraints.
4. The patient's record did not contain a one-hour physician evaluation as required by facility policy "Restraint and Seclusion," EHR010, which states that when restraints are applied for violent or self-destructive behavior: "Physicians/PA's (Physician Assistants) must perform a face-to-face assessment of the initiation of restraint/seclusion."
5. On 12/27/12 at approximately 3:30 pm the Emergency Department Administrator stated that patient #'2's episode of restraint on 8/22/12 should have been ordered for violent, not non-violent behavior and was subject to the 1-hour face-to-face assessment requirement noted in hospital policy EHR010. The ED Administrator verified that the clinical record did not contain evidence of a 1-hour face-to-face assessment being completed.