HospitalInspections.org

Based on review of facility documents, medical records (MR), and staff interview (EMP), it was determined the facility failed to ensure a physician ordered the body net restraint on an adolescent patient in one of one medical records reviewed (MR1).

Findings include:

Review on May 9, 2017, of facility policy, "Restraints and Seclusion," dated last approved January 15, 2016, revealed "Purpose Pocono Medical Center believes that patients have the right to be free from both physical and chemical restraint. Restraints are never used as a punishment to the patient or for the convenience of staff, but are used only in an emergency situation, when there is imminent risk of an individual physically harming self or others, including staff. ... Guidelines Reasons for restraints, regardless of the location of the patient within the hospital. Medical/Surgical-To promote medical healing. (To avoid treatment interruptions or to permit active interventions.) Behavioral Health (Violent and/or Self-Destructive behavior)-To protect the individual against injury to self or others because of an emotional or behavioral disorder. ... Definitions 1. Physical Restraint: A device used with the intent to physically restrict a person's freedom of movement, physical activity, or normal access to his/her body. ... General Information:. ... 2. Documentation: (see specifics at the end of the policy for reason-specific requirements) a. Every episode of restraint use is to be documented via the Restraint Order Sheet, Restraint/Seclusion Checklist, and the Care/Treatment Plan. ... Behavioral Health (Violent and/or Self Destructive behavior) Reasons 1. Restraints can be initiated by a Registered Nurse (RN) only after interventions to modify behaviors are attempted, documented and found to be unsuccessful prior to a decision to restrain a patient. 2. Following the initiation of restraints, the RN/LPN immediately needs to obtain a physician's order on the Restraint Order Sheet. Time limit is specified by physician, but not to exceed the following: a. 4 hours for the adult (18 years and older) b. 2 hours for the child/adolescent (9-17 years old) c. 1 hour for the child (under 9 years old) 3. The physician's order needs to include the reason for the restraint, time limitation of restraint, physician's signature, date and time of order 4. Within 1 hour of restraint application, a face-to-face evaluation by the physician or Licensed Independent Practitioner needs to be completed. The least restrictive restraining device is to be ordered to provide patient safety. 5. Equipment that may be used include the following: a. Key-Locking Vinyl Cuff Restraints for the behavioral health unit (BHU) b. Key-locking waist belt (BHU) c. Keyless Locking Vinyl Cuff Restraints for medical/surgical and Emergency Departments areas d. Body Net (limited to BHU and the Emergency Department) e. Seclusion (limited to BHU and the Emergency Department) f. Chemical Restraints 6. When restraints are used for Behavioral Health Reasons, continuous in person observation with 'every 15-minute' documentation will be done by the observer using the Restraint/Seclusion Checklist/Assessment Sheet. (This includes patients in a non-psychiatric setting in restraints for Behavioral Health Reasons) 7. Before the order expires, the patient is to receive another face-to-face re-evaluation. This re-evaluation can be done by the physician/LIP or a BHU RN. If the RN is the re-evaluator, he/she may obtain a telephone order to continue the restraint for an additional 4-hour time frame. When this order expires, another face to face evaluation must be made by the physician/LIP to determine continued need for restraint. A new Restraint Order Sheet is to be completed. ..."

Review of MR1 on May 9, 2017, revealed the 16-year-old was admitted to the Emergency Department (ED) on April 4, 2017, at 0653 for evaluation and treatment of an intentional overdose (OD). The patient was discharged from the ED on April 7, 2017, at 1450. Nursing documentation dated April 5, 2017, at 17:51 revealed MR1 was placed in restraints, a "nut net." There was no physician order instructing nursing staff to place MR1 in the "nut net" on April 5, 2017. Further review revealed no physician documentation for the reason for this restraint.

Interview on May 9, 2017, with EMP1 confirmed MR1 was placed in restraints and nursing staff documented the use of the body net as a nut net on April 5, 2017, at 17:51. EMP1 confirmed a body net would be considered a restraint, and a physician order should have been obtained.

Based on review of facility documents, medical records (MR), and staff interview (EMP), it was determined the facility failed to ensure a physician order for a restraint on an adolescent patient did not exceed 2 hours for one of one medical records reviewed (MR1), and failed to ensure a physician order for restraint specified specific time limits in one of one medical record reviewed (MR2).

Findings include:

Review on May 9, 2017, of facility policy, "Restraints and Seclusion," dated last approved January 15, 2016, revealed "Purpose Pocono Medical Center believes that patients have the right to be free from both physical and chemical restraint. Restraints are never used as a punishment to the patient or for the convenience of staff, but are used only in an emergency situation, when there is imminent risk of an individual physically harming self or others, including staff. ... Behavioral Health (Violent and/or Self Destructive behavior) Reasons 1. Restraints can be initiated by a Registered Nurse (RN) only after interventions to modify behaviors are attempted, documented and found to be unsuccessful prior to a decision to restrain a patient. 2. Following the initiation of restraints, the RN/LPN immediately needs to obtain a physician's order on the Restraint Order Sheet. Time limit is specified by physician, but not to exceed the following: a. 4 hours for the adult (18 years and older) b. 2 hours for the child/adolescent (9-17 years old) c. 1 hour for the child (under 9 years old) 3. The physician's order needs to include the reason for the restraint, time limitation of restraint, physician's signature, date and time of order

Review of MR1 on May 9, 2017, revealed the 16-year-old was admitted to the Emergency Department (ED) on April 4, 2017, at 0653 for evaluation and treatment of an intentional overdose (OD). The patient was discharged from the ED on April 7, 2017, at 1450. The physician order for restraints dated April 4, 2017, at 1415 had a 4-hour time limit.

Interview on May 9, 2017, with EMP1 confirmed MR1 was an adolescent patient. EMP1 confirmed the physician ordered restraints on April 4, 2017, at 1415 with a 4-hour time limit.

Review on May 15, 2017, of MR2 revealed a 35-year old patient admitted to the ED on May 7, 2016. A body net was ordered at 2:03 AM for behavioral health reasons. The time limit for the body net restraint was not specified by the physician.

Phone interview on May 15, 2017, with EMP1 confirmed MR2 was placed in a body net on May 7, 2016 at 2:05 AM. EMP1 confirmed the physician did not specify a time limit for the body net restraint.

Cross reference:
482.13(3)(5) Patient Rights: Restraint or Seclusion

Based on review of facility documents, medical records (MR), and staff interview (EMP), it was determined the facility failed to ensure 15 minute observation checks for patients in restraints were completed in two of two medical records reviewed (MR1 and MR2.)

Findings include:

Review on May 9, 2017, of facility policy, "Restraints and Seclusion," dated last approved January 15, 2016, revealed "Purpose Pocono Medical Center believes that patients have the right to be free from both physical and chemical restraint. Restraints are never used as a punishment to the patient or for the convenience of staff, but are used only in an emergency situation, when there is imminent risk of an individual physically harming self or others, including staff. ... General Information:. ... 6. When restraints are used for Behavioral Health Reasons, continuous in person observation with 'every 15-minute' documentation will be done by the observer using the Restraint/Seclusion Checklist/Assessment Sheet. (This includes patients in a non-psychiatric setting in restraints for Behavioral Health Reasons) ..."

Review of MR1 on May 9, 2017, revealed the 16-year-old was admitted to the Emergency Department (ED) on April 4, 2017, at 0653 for an evaluation and treatment of an intentional overdose (OD). Nursing documentation dated April 5, 2017, at 17:51 that MR1 was placed in restraints, a nut net. The restraints were released on April 5, 2017 at 23:01. There was no documentation the required 15 minute observation checks were completed.

Interview on May 9, 2017, with EMP1 confirmed MR1 was placed in restraints on April 5, 2017, at 17:51. EMP1 confirmed the required 15 minute observation checks on the Restraint/Seclusion Checklist/Assessment Sheet were not completed.

Review on May 15, 2017, of MR2 revealed a 35-year-old patient admitted to the ED on May 7, 2016. The patient was placed in a body net at 2:05 AM for behavioral health reasons. There was no documentation the required 15 minute observation checks were completed.

Phone interview on May 15, 2017, with EMP1 confirmed MR2 was placed in a body net on May 7, 2016, at 2:05 AM. EMP1 confirmed the required 15 minute observation checks on the Restraint/Seclusion Checklist/Assessment Sheet were not completed.

Cross reference:
482.13(3)(5) Patient Rights: Restraint or Seclusion

Based on review of facility documents, medical records (MR) and staff interview (EMP), it was determined the facility failed to ensure a patient with suicidal thoughts and actions was not provided utensils while a patient in the Emergency Department for one of one applicable medical record reviewed (MR1).

Findings include:

Review on May 9, 2017, of the facility's "Effective Security Patrolling" policy, no review date, revealed "Purpose the primary responsibility of Pocono Health System Security Department is to maintain a safe and secure environment in which to administer patient care. Part of the Pocono Health System's security system includes regular foot patrols by security officers on prevention and deterrence, discovery and apprehension of criminal subjects and identification of potential safety hazards. ..."

Review on May 9, 2017, of the facility's "Limited Authority / Use of Force / Search and Seizure" policy, effective July 19, 2016, revealed "1. Purpose the purpose of this policy is to describe a Security Officer's authority to act in situations where detainment, use of force, or search and seizure may be necessary for protecting persons and property under the care and responsibility of the Pocono Medical Center. 2. Procedure a Security Officer's legal authority is delineated in three segments as follows; A. Detainment B. Use of Force C. Search and Seizure ..."

Review on February 1, 2017, of the Manager, Safety and Security, job description, last reviewed November 10, 2015, revealed, "Job Summary: Responsible for developing, implementing and monitoring systems, programs and policies designed to promote a safe and secure environment in which to administer patient care. Coordinates activities of the Security Department to provide protective services for patients, visitors, employees and corporate assets. Major Tasks, Duties, and Responsibilities: Is responsible for the development of a comprehensive physical Security program and directs operations of Security Services Department which is responsible for maintaining a safe environment for our staff, patients and visitors - 24/7. ... ."

Review of MR1 on May 9, 2017, revealed the patient was admitted to the Emergency Department (ED) on April 4, 2017, for evaluation and treatment of an intentional overdose. Nursing documentation revealed on April 6, 2017, at 8:32 AM, the patient received a Safe Tray for breakfast. At 13:52, the patient ate French fries and a peanut butter and jelly sandwich. At 15:00 EMP4 made rice for the patient from the kitchen.

Interview with EMP4 on May 9, 2017, at approximately 9:45 AM confirmed EMP4 provided MR1 with rice. EMP4 confirmed they also provided MR1 with a spoon to eat the rice. EMP4 revealed intervening on behalf of the patient and providing food and utensils to a mental health patient promoted a relationship and trust with the patient. EMP4 revealed they were a Security Guard and was not trained to provide psychiatric care or interventions to a patient with suicidal thoughts or actions.

Interview with EMP5 on May 9, 2017, at approximately 1:30 PM revealed all patients with suicidal thoughts and actions were provided a Safe Tray. The Safe Try included the paper trays, Styrofoam cups, finger foods, and no utensils. EMP5 revealed there was no facility policy, procedure or guideline for facility staff to follow regarding a Safe Tray.

Interview with EMP1, EMP2, EMP3 and EMP4 on May 9, 2017, at approximately 10:00 AM confirmed EMP4 provided MR1 with rice and a spoon; MR1 was in the ED due to a suicidal attempt; and MR1 was to have only paper trays, Styrofoam cups, finger foods and no utensils.

Continuing deficiency cited February 1, 2017