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Based on document review and staff interview it was determined the Emergency Department (ED) nursing staff failed to follow the physician order for the type of restraints used and where to apply the restraints for one (1) of ten (10) records reviewed (patient #1). This failure has the potential to adversely affect all patients.

Findings include:

1. A review of the medical record for patient #1 revealed the patient was brought into the ED by Emergency Medical Services on 3/20/18 at 12:10 p.m. with suicidal ideations. The patient attempted to leave the ED and was escorted back to her room by security. The patient was documented as being extremely anxious and confrontational. The ED physician ordered soft limb restraints to be applied to the upper extremities because she was a threat to herself, and to keep her from eloping. The ED flowsheet revealed patient #1 was placed in rigid restraints on 3/20/18 at 2:13 p.m., upper and lower extremities. Patient #1 was discharged to the court/sheriff on 3/20/18 at 4:01 p.m.

2. A review of the physician's order for restraints for patient #1 revealed the following: "Restraint initiate non-violent. start time 3/20/18 at 13:34 p.m., end time 3/20/18 at 14:13 p.m., order details: Prevent treatment disruption and injury, soft limb, Location: Bilateral upper extremities."

3. An interview was conducted with Registered Nurse (RN) #1 on 4/17/18 at 8:30 a.m. When asked if she remembered patient #1, she said, "Yes." She stated when the physician ordered restraints, the patient was restrained. She stated she restrained her arms and legs. She stated patient #1 started yanking on the restraints and threatening security. She reported patient #1 was in restraints until the sheriff arrived. She stated RN #2 was in the room when the restraints were being put on.

4. An interview was conducted with the ED Director of Nursing on 4/18/18 at 9:10 a.m. She concurred the ED nursing staff did not follow the physician's orders regarding the application of soft limb restraints to the upper extremities.

Based on document review and staff interview it was determined the Emergency Department (ED) nursing staff failed to follow the physician's order for restraint of the patient in one (1) of ten (10) records reviewed (patient #1). This failure has the potential to adversely affect all patients.

Findings include:

1. A review of the medical record for patient #1 revealed the patient was brought into the ED by Emergency Medical Services on 3/20/18 at 12:10 p.m. with suicidal ideations. The patient attempted to leave the ED and was escorted back to her room by security. Patient #1 was documented as being extremely anxious and confrontational. The ED physician ordered soft limb restraints to be applied to the upper extremities because she was a threat to herself, and to keep her from eloping. The ED flowsheet revealed patient #1 was placed in rigid restraints on 3/20/18 at 2:13 p.m., upper and lower extremities. Patient #1 was discharged to the court/sheriff on 3/20/18 at 4:01 p.m.

2. A review of the physician's order for restraints for patient #1 revealed the following: "Restraint initiate non-violent. start time 3/20/18 at 13:34 p.m., end time 3/20/18 at 14:13 p.m., order details: Prevent treatment disruption and injury, soft limb, Location: Bilateral upper extremities."

3. An interview was conducted with Registered Nurse (RN) #1 on 4/17/18 at 8:30 a.m. When asked if she remembered patient #1, she said, "Yes." She stated when the physician ordered restraints, the patient was restrained. She stated she restrained her arms and legs. She stated patient #1 started yanking on the restraints and threatening security. She stated patient #1 was in restraints until the sheriff arrived. She stated RN #2 was in the room when restraints were being put on.

4. An interview was conducted with the ED Director of Nursing on 4/18/18 at 9:10 a.m. She concurred the ED nursing staff did not follow the physician's orders regarding the application of soft limb restraints to the upper extremities.