HospitalInspections.org

Based on observation, interview and record review the facility failed to ensure the physician sign orders for restraints every 24 hours as required for one of two patients in restraints. The census was 386.

Observation on 2/5/10 at 12:00 p.m. revealed Patient # 2 was in a room across from the nurse's station in a bed enclosure which was completely enclosed by netting which prevented the patient from getting out of bed.

Record review of the patient's chart revealed the patient had been admitted to the facility on 1/29/10 with acute congestive heart failure (CHF) [the heart does not pump adequately].

Past History: (in part)
Dementia of Alzheimer's disease, which is becoming worse and the patient lives in a care facility.

Record review of the Physician Orders revealed no signature, date or time for the restraint orders of bed enclosure and Gerichair (a chair which allows a patient to be put in multiple positions) with latched tray on the initial order of 2/2/10 or the renewal orders of 2/3/10, 2/4/10 or 2/5/10.

Record review on 2/5/10 at 2:50 p.m. of the Physicians Order for restraints revealed the physician had signed the orders but they were not dated or timed.

During an interview on 2/5/10 at 12:05 p.m. Registered Nurse A stated the patient had a bed enclosure around her bed to keep her safe since she was confused and a fall risk. RN A stated the patient had several times tried to get out of bed without assistance and the staff had tried other interventions such as a hi/lo bed and a personal alarm but the patient was too quick and the netting had been applied several days ago.

During an interview on 2/5/10 at 12:15 p.m. Unit Manager B stated he/she did not see signatures on the Order for Restrain, initial order taken 2/2/10 or the renewal orders of 2/3/10, 2/4/10 or 2/5/10. Unit Manager B stated he/she would contact the physician.

During an interview on 2/5/10 at 1:02 p.m. Physician C stated he/she thought the policy for signing restraint orders was 24 hours and the orders were not signed because he/she "probably forgot because he had so many patients". When asked if the staff had reminded he/she of the need to sign the restraint orders every 24 hours; he/she stated I'm not sure if they told me or not".

Record review of the facility policy titled Restraint Protocol-Medical dated 2/19/09 stated in part the following:

Supportive data:
6. A physician's order or Licensed Independent Practitioner (LIP) [an Advanced Practice Nurse with a collaborative physician agreement] must be obtained and written promptly when restraint placement becomes necessary. The order must be written for every application of a restraint. The order:
a.. must indicate the date and time it was written
b. must include the type of restraint and the reason it is needed, and
c. must not be written as "prn."
The restraint may be placed for no longer than 24 hours without a renewal order.