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Based on clinical record review and interview, it was determined the Facility failed to provide five (#1, #3, #5, #6 and #7) of six (#1, #3-#7) patients with a copy of the Important Notice in advance of discharge. Failure to provide the patient with a copy of the Important Notice did not allow the patients to be informed and knowledgeable of their rights prior to discharge from the facility. The failed practice affected five (#1, #3, #5, #6 and #7) of six (#1, #3-#7) discharged patients on 03/04/13. Findings follow:

A. Review of five (#1, #3, #5-#7) of six (#1, #3-#7) closed clinical records revealed there was no Important Notice given to the patients in advance of discharge.

B. The above findings were verified by the Chief Nursing Officer at 1245 on 03/04/13.

Based on review of Patient Rights documents and interview, it was determined the Facility failed to include the State Agency's address on the Patient Rights documents given to patients on admission to the hospital. Failure to include the State Agency's address did not allow patients to place their complaint in writing and send to the State Agency. The failed practice affected all patients admitted to the facility. Findings follow:

A. Review of the Patient's Rights statement received from the Chief Nursing Officer at 1100 on 03/04/13 revealed the State Agency's address was not listed on the form.

B. The above was verified by the Chief Nursing Officer at 1300 on 03/04/13.

Based on clinical record review, policy and procedure review and interview it was determined the Facility restrained one (#5) of three (#3, #5 and #7) patients without physician orders. Failure to obtain physician orders for restraints did not allow the physician to be knowledgeable of the patient's need for restraints and prohibited the Facility from following its policy. The finding had the potential to affect any patient in restraints. Findings follow:

A. Review of Patient #5's clinical record revealed every two hours restraint checks documented on the Restraint Flowsheets dated February 13th and 14th of 2013. Review of the physician's orders did not reveal any orders for Patient #5 to be restrained.

B. Review of Facility policy and procedure titled "Restraint Management Nursing Protocol" received from the Chief Nursing Officer at 1100 on 03/04/13 revealed ...The use of restraints is a dependent intervention and requires a physician order ...

C. The above findings were verified by the Chief Nursing Officer at 1400 on 03/04/13.

Based on clinical record review, policy and procedure review, Medical Staff Rules and interview, it was determined the Facility failed to ensure restraint orders were issued per Facility Policy and Procedure and Medical Staff Rules. Facility policy and procedure titled Restraint Management, Nursing Protocol, second paragraph stated "The issue of physically restraining a patient is a difficult emotional and legal issue. The use of restraints is a dependent intervention and requires a physician's order for implementation ..." Review of the Medical Staff Rules, section 19.1.5 revealed "Except as specified herein, all orders for treatment shall be in writing, signed, dated and timed before being carried out." Failure to time restraint orders did not allow the physician and the nursing staff to be cognizant of the 24 hour time limit for restraint orders to be renewed. The failed practice affected Patients #3 and #7. Findings follow:

A. Review of Patient #3's clinical record revealed Physician #2 failed to time two restraint orders dated 01/28/13.

B. Review of Patient #7's clinical record revealed Physician #3 failed to time two restraint orders dated 11/16/12 and 11/17/13.

C. The above findings were confirmed by the Chief Nursing Officer at 1255 on 03/04/13.