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Based on policy and procedure review, clinical record review, and interview, it was determined the facility failed to ensure a licensed nurse assessed three (#17-#19) of five (#16-#20) patients while in restraints every two hours per the facility's policy and procedure. The failed practice did not ensure the patient's skin integrity, nutrition and hydration, hygiene and elimination, signs of injury or distress, circulation needs were met or to determine if the restraints could be discontinued. The failed practice had the potential to affect all patients in restraints. Findings included:

A. Review of the facility's policy titled, "Restraint/Seclusion," with an effective date of 11/03/17 showed a licensed nurse must assess patients in restraints every two hours for, at a minimum, skin integrity, nutrition and hydration, hygiene and elimination, signs of injury or distress, circulation needs or to determine if the restraints could be discontinued. Documentation of the assessment should occur every two hours.
B. The findings of A were confirmed in an interview with the Director of Accreditation and Case Management on 01/26/18 at 10:10 AM.
C. Review of Patient #17's clinical record on 01/26/18 showed the patient was in restraints on 01/23/18 from 2:10 PM to 10:00 PM. There was no evidence the patient's skin integrity, nutrition and hydration, hygiene and elimination, signs of injury or distress, circulation needs, or determination if the restraints could be discontinued were assessed every two hours from 01/23/18 at 2:10 PM to 10:00 PM. The findings were confirmed in an interview with the Director of Accreditation and Case Management on 01/26/18 at 10:10 AM.
D. Review of Patient #18's clinical record on 01/26/18 showed the patient was in restraints from 01/10/18 at 10:55 PM to 01/17/18 at 2:00 PM. There was no evidence the patient's skin integrity, nutrition and hydration, hygiene and elimination, signs of injury or distress, circulation needs or determination if the restraints could be discontinued were assessed every two hours from 01/13/18 at 6:00 PM to 01/14/18 at 4:00 AM, from 01/15/18 at 10:00 AM to 01/15/18 at 8:00 PM, and from 01/17/18 at 4:00 PM to 01/17/18 at 6:00 AM. The findings were confirmed in an interview with the Director of Accreditation and Case Management on 01/26/18 at 10:25 AM.
E. Review of Patient #18's clinical record on 01/26/18 showed the patient was in restraints from 01/10/18 at 7:00 PM to 01/25/18 at 2:00 PM. There was no evidence the patient's skin integrity, nutrition and hydration, hygiene and elimination, signs of injury or distress, circulation needs or determination if the restraints could be discontinued were assessed every two hours from 01/12/18 at 6:00 PM to 01/13/18 at 8:00 AM, from 01/15/18 at 6:00 AM to 01/15/18 at 1:00 PM, from 01/20/18 at 10:00 AM to 01/20/18 at 8:00 PM, and from 01/25/18 at 2:00 AM to 01/25/18 at 8:00 AM. The findings were confirmed in an interview with the Transplant Administrator on 01/26/18 at 10:45 AM.

Based on clinical record review, Medical Staff Bylaws review, and interview, it was determined the facility failed to ensure two (#9 and #10) of seven (#4-#10) Emergency Room records were complete in that they did not contain a Licensed Independent Practitioner assessment. The failed practice did not ensure the record was complete to provide patient information for the continuity of the patient's care. Findings included:

A. Record review of the "Medical Staff Bylaws, Policies, and Rules and Regulation of Arkansas Children's Hospital" with an approved date of 08/30/17 showed the emergency record shall be documented at the time of service, but no later than immediately following discharge/transfer of the patient from the Emergency Department.
B. The findings of B were confirmed in an interview with the Director of Accreditation and Case Management on 01/26/18 at 1:35 PM.
C. Review of Patient #9's clinical record on 01/26/18 showed the patient was seen in the Emergency Room on 01/24/18. There was no evidence of a Licensed Independent Practitioner's assessment. The findings were confirmed in an interview with the Patient Care Manager in the Emergency Department on 01/26/18 at 12:55 PM.
D. Review of Patient #10's clinical record on 01/26/18 showed the patient was seen in the Emergency Room on 01/24/18. There was no evidence of a Licensed Independent Practitioner's assessment. The findings were confirmed in an interview with the Patient Care Manager in the Emergency Department on 01/26/18 at 1:00 PM.