HospitalInspections.org

Based on record review, staff interview and review of facility restraint policy the facility failed to ensure 1 of 1 sampled patients (Patient 4) utilizing physical behavioral restraints had a renewal for continued restraint use after the previous order expired. The total sample size was 11. Findings are:

A. Record review of Emergency Department (ED) patient record for Patient 4 revealed the patient came to the ED with police on 6/3/12 at 3:18 AM. Admitting assessment data notes the patient had depression, bizarre behavior with suicidal and homicidal thoughts while in jail after a Driving while Under the Influence arrest. The patient was under the influence of alcohol with a blood alcohol level of 202 recorded at admission. Police handcuffs were on the patient on arrival and removed with the placement of hospital vinyl Velcro behavioral locking restraints to all 4 extremities placed at 3:45 AM. Review of ED physician orders reveals the original order for the behavioral physical restraint for 4 hrs dated 6/3/12 at 3:45 AM. At 7:45 AM (4 hours later) the order was renewed by the physician for another 4 hours. Nursing assessments identified the patient was still unable to contract for safety of others. The second restraint order at 7:45 AM expired at 11:45 AM. A renewal order was not written by the physician or a verbal order obtained by nursing. Restraint documentation demonstrates the patient continued to have 1 extremity restrained in a hospital applied restraint until transfer at 1:35 PM on 6/3/12 to a Mental Health facility. This finding was confirmed by interview with the ED Registered Nurse Manager on 8/10/12 at 12:40 PM.

B. Record review of facility policy titled "Restraints" effective date of 5/17/10 notes under Section E that "Physician Order for Adult patients restrained because of violent or self destructive behavior 1. Initial orders for adult patients restrained because of violent behavior will be: maximum of four hours." Under Part 2 the policy states "Re-evaluation of the continuation of the behavioral restraint order must be done in person as a 'face to face' assessment and written by the treating physician or as a verbal order by the registered nurse using the same parameters."