HospitalInspections.org

Based on policy and procedure reviews, Quality Care Committee minutes, medical record reviews, and staff and physician interviews, the facility staff failed to identify and monitor chemical restraints in 5 of 5 patients medical records with chemical restraints reviewed. (Patient #1; #2; #6; #10; and #17)

Findings included:

Review on 06/02/2023 of the facility policy titled "Restraints," original date: 11/01/2015 revealed "...Chemical Restraint: any medication used to restrict or manage a patient`s behavior that is not a standard treatment or dosage being used to treat a specific condition. Medications that are not considered restraints include therapeutic doses of psychotropic medications for patient suffering with mental illness to improve their level of function so they can actively participate in their treatment ...Doses of medication above the ranges specified in the following table should be considered chemical restraints when used in the facility." Haldol 0.5- 10 milligrams intramuscular or intravascular and Geodon 20-40 milligrams intramuscular were two of eight medications listed in the table. "...ORDERING RESTRAINTS: ...Each episode of restraint (chemical, mechanical, physical hold) must be ordered individually ...I. 1- Hour Face-To-Face Evaluation- Must be completed within 1 hour of restraint application ...CHEMICAL RESTRAINTS: ...Vital signs frequency is: Q [ every]15 min [minutes] X [times] 4, Q30 min X 2; and Q1hr [hour] x 1. ...Document Q15 monitoring & vital signs X4, 1 hr assessment, Q30 min monitoring& vital signs X2, then Q1 hr monitoring & vital signs X1..."
Review of the Quality Care Committee minutes for 01/01/2023 through 06/02/2023 revealed no chemical restraints had been identified at the facility.
1. Medical record review on 05/31/2023 of patient #1 revealed an 81-year-old male patient admitted for complicated urinary tract infection and a kidney stone. The patient`s medical history included Parkinson`s disease (a progressive disease effecting the nervous system, and can cause uncontrolled movements, mental changes, and memory difficulties), neuropathy (weakness, numbness and pain in extremities from nerve damage), high blood pressure, and orthostatic hypotension (blood pressure drops upon standing). Review revealed Patient #1 was administered Haldol (Antipsychotic medication used for anxiety, agitation and behaviors) on 01/05/2023 at 0254 times one dose for agitation, pulling out IV (needle placed in a vein) and trying to get out of bed, and yelling. Review revealed Haldol was not a part of the patient`s treatment plan. Review revealed the chemical restraint was not identified or monitored per facility policy.

Interview on 05/30/2023 at 1530 with the Manager of the Patient Care Unit, RN #1, revealed that they "do not use chemical restraints," and it was "not our intent to." Interview revealed the practice was based on part of their policy that listed if dosages exceeded a specific amount for eight different medications, then a chemical restraint was to be identified.

Interview on 05/31/2023 at 1430 with Physician #2, who worked night shift, revealed patient safety was the primary reason for medications ordered for agitated patients. Interview revealed many times family or employee sitters were not available at night and with the potential for harm, "I will go with low doses of medications" to help the patients.

Interview on 06/02/2023 at 0930 with the Chief Medical Officer, Physician #3, defined a chemical restraint as a drug that debilitates a patient. Interview revealed it was his expectation that if a chemical restraint was ordered that the patient was monitored as such. During interview patient`s #1; #2; #6; and #10 were discussed regarding the use of a chemical restraint and no documentation identifying or monitoring the chemical restraints.

Interview on 06/02/2023 at 1000 with the Chief Nursing Officer, RN #4, revealed that their policy needed to be revised, remove dosage perimeters, to be in line with the definition of a chemical restraint. Interview confirmed chemical restraints were not identified or monitored.

2. Medical record review on 05/31/2023 of patient #2 revealed a 76-year-old male patient admitted to the facility on 02/20/2023 for alcohol abuse and failure to thrive. The patient`s medical history included Parkinson`s disease, dementia (decline in mental function-memory, thinking and social skills), alcohol abuse and weakness. Review revealed patient #2 received Haldol 5 mg intramuscularly on 02/16/2023 at 0035 for combative and assaultive behaviors times one dose and Haldol 2.5 mg intramuscularly on 02/18/2023 at 2101 for combative and assaultive behaviors times one dose. Review revealed Haldol was not a part of the patient`s treatment plan. No documentation available for chemical restraint noted. Review revealed the chemical restraint was not identified or monitored per facility policy.

Interview on 05/30/2023 at 1530 with the Manager of the Patient Care Unit, RN #1, revealed that they "do not use chemical restraints," and it was "not our intent to." Interview revealed the practice was based on part of their policy that listed if dosages exceeded a specific amount for eight different medications, then a chemical restraint was to be identified. Interview revealed all the physicians had access to patient`s medical records.

Interview on 05/31/2023 at 1430 with Physician #2, who worked night shift, revealed patient safety was the primary reason for medications ordered for agitated patients. Interview revealed many times family or employee sitters were not available at night and with the potential for harm, "I will go with low doses of medications" to help the patients.

Interview on 06/02/2023 at 0930 with the Chief Medical Officer, Physician #3, defined a chemical restraint as a drug that debilitates a patient. Interview revealed it was his expectation that if a chemical restraint was ordered that the patient was monitored as such. During interview patient`s #1; #2; #6; and #10 were discussed regarding the use of a chemical restraint and no documentation identifying or monitoring the chemical restraints.

Interview on 06/02/2023 at 1000 with the Chief Nursing Officer, RN #4, revealed that their policy needed to be revised, remove dosage perimeters, to be in line with the definition of chemical restraint. Interview confirmed chemical restraints were not identified or monitored.

3. Medical record review on 05/31/2023 of patient #6 revealed an 81-year-old male patient admitted to the facility on 01/01/2023 for weakness, fall, and blood in urine. The patient`s medical history included chronic kidney failure, diabetes, Alzheimer 's disease (progressive loss of memory and cognitive abilities that interfere with daily life) alcohol use and advanced dementia. Review revealed patient #6 received Haldol 5 mg intravenously on 01/03/2023 at 0442 times one dose; and Haldol 2 mg intramuscularly on 01/13/2023 at 2324 times one dose for agitation, combative behavior, and pulling out medical devices. Review revealed patient #6 received Geodon (antipsychotic medication used for agitation, and to decrease hallucinations) 5 mg intramuscularly on 01/03/2023 at 0442 times one dose; 20 mg intramuscularly on 01/05/2023 at 2222 times one dose; 20 mg intramuscularly on 01/10/2023 at 2036 times one dose; and 10 mg intramuscularly on 01/11/2023 at 0649 times one dose, for agitation and combative behaviors. Review revealed Haldol nor Geodon were not a part of the patient`s treatment plan. No documentation available for chemical restraint noted. Review revealed the chemical restraint was not identified or monitored per facility policy.

Interview on 05/30/2023 at 1530 with the Manager of the Patient Care Unit, RN #1, revealed that they "do not use chemical restraints," and it was "not our intent to." Interview revealed the practice was based on part of their policy that listed if dosages exceeded a specific amount for eight different medications, then a chemical restraint was to be identified. Interview revealed all the physicians had access to patient`s medical records.

Interview on 05/31/2023 at 1430 with Physician #2, who worked night shift, revealed patient safety was the primary reason for medications ordered for agitated patients. Interview revealed many times family or employee sitters were not available at night and with the potential for harm, "I will go with low doses of medications" to help the patients.

Interview on 06/02/2023 at 0930 with the Chief Medical Officer, Physician #3, defined a chemical restraint as a drug that debilitates a patient. Interview revealed it was his expectation that if a chemical restraint was ordered that the patient was monitored as such. During interview patient`s #1; #2; #6; and #10 were discussed regarding the use of a chemical restraint and no documentation identifying or monitoring the chemical restraints.

Interview on 06/02/2023 at 1000 with the Chief Nursing Officer, RN #4, revealed that their policy needed to be revised, remove dosage perimeters, to be in line with the definition of chemical restraint. Interview confirmed chemical restraints were not identified or monitored.

4. Medical record review on 05/31/2023 of patient #10 revealed a 79-year-old female patient admitted to the facility on 01/09/2023 for acute encephalopathy (disturbance of brain function that involves confusion, personality changes, and trouble thinking). The patient`s medical history included chronic kidney disease, chronic pain, and high blood pressure. Review revealed patient #10 received Haldol 1 mg intravenously on 01/01/2023 at 0237 times one dose for agitation, trying to get out of bed, and assaultive behaviors. Review revealed patient #10 received Geodon (antipsychotic medication used for agitation, and to decrease hallucinations)10 mg intramuscularly on 01/11/2023 at 0127 times one dose for agitation, trying to get out of bed, and assaultive behaviors. Review revealed Haldol nor Geodon were not a part of the patient`s treatment plan. No documentation available for chemical restraint noted. Review revealed the chemical restraint was not identified or monitored per facility policy.

Interview on 05/30/2023 at 1530 with the Manager of the Patient Care Unit, RN #1, revealed that they "do not use chemical restraints," and it was "not our intent to." Interview revealed the practice was based on part of their policy that listed if dosages exceeded a specific amount for eight different medications, then a chemical restraint was to be identified. Interview revealed all the physicians had access to patient`s medical records.

Interview on 05/31/2023 at 1430 with Physician #2, who worked night shift, revealed patient safety was the primary reason for medications ordered for agitated patients. Interview revealed many times family or employee sitters were not available at night and with the potential for harm, "I will go with low doses of medications" to help the patients.

Interview on 06/02/2023 at 0930 with the Chief Medical Officer, Physician #3, defined a chemical restraint as a drug that debilitates a patient. Interview revealed it was his expectation that if a chemical restraint was ordered that the patient was monitored as such. During interview patient`s #1; #2; #6; and #10 were discussed regarding the use of a chemical restraint and no documentation identifying or monitoring the chemical restraints.

Interview on 06/02/2023 at 1000 with the Chief Nursing Officer, RN #4, revealed that their policy needed to be revised, remove dosage perimeters, to be in line with the definition of chemical restraint.

5. Medical record review on 05/31/2023 of patient #17 revealed a 93-year-old male patient admitted to the facility on 05/31/2023 for sepsis (life threatening complication of an infection) and gallbladder inflammation. The patient`s medical history included diabetes, dementia and chronic kidney disease and was non-ambulatory. Review revealed patient #17 received Haldol 1 mg intravenously on 05/31/2023 at 0053 times one dose for agitation. Review revealed Haldol was not a part of the patient`s treatment plan. No documentation available for chemical restraint noted. Review revealed the chemical restraint was not identified or monitored per facility policy.

Interview on 05/30/2023 at 1530 with the Manager of the Patient Care Unit, RN #1, revealed that they "do not use chemical restraints," and it was "not our intent to." Interview revealed the practice was based on part of their policy that listed if dosages exceeded a specific amount for eight different medications, then a chemical restraint was to be identified. Interview revealed all the physicians had access to patient`s medical records.

Interview on 05/31/2023 at 1430 with Physician #2, who worked night shift, revealed patient safety was the primary reason for medications ordered for agitated patients. Interview revealed many times family or employee sitters were not available at night and with the potential for harm, "I will go with low doses of medications" to help the patients.

Interview on 06/02/2023 at 0930 with the Chief Medical Officer, Physician #3, defined a chemical restraint as a drug that debilitates a patient. Interview revealed it was his expectation that if a chemical restraint was ordered that the patient was monitored as such. During interview patient`s #1; #2; #6; and #10 were discussed regarding the use of a chemical restraint and no documentation identifying or monitoring the chemical restraints.

Interview on 06/02/2023 at 1000 with the Chief Nursing Officer, RN #4, revealed that their policy needed to be revised, remove dosage perimeters, to be in line with the definition of chemical restraint. Interview confirmed chemical restraints were not identified or monitored.