HospitalInspections.org

Based on document review and interview, it was determined that for 1 of 5 records (Pt. #1) reviewed for restraint use, the hospital failed to ensure that restraint used was in accordance with a physician's order.

Findings include:

1. The hospital's policy titled, "Restraint Use: Non-Violent/Non-Self-Destructive and Violent/Self-Destructive" (5/25/2023), was reviewed and required, "Obtaining a restraint order: If alternatives to restraints prove unsuccessful and the patient remains a risk to self/others: 1. Obtain order for restraint from LIP [licensed independent practitioner] who is authorized for the care of the patient prior to restraint application..."

2. The clinical record of Pt. #1 was reviewed on 9/6/2023. Pt. #1 was admitted on 7/8/2023, with diagnoses of syncope (fainting) and collapse, NSTEMI (non-ST elevated myocardial infarction/heart attack - damage to the heart muscle caused by a loss of blood supply due to blocks in the arteries), community-acquired pneumonia (infection) of right lower lobe of lung, and hypercalcemia (high blood calcium levels). Nursing assessments indicated that Pt. #1 was confused and a high fall risk. Nursing flowsheets indicated that Pt. #1 was placed in a posey (enclosure) bed on 7/9/2023, at approximately 7:15 PM (by Registered Nurse E#2), due to attempting to get out of bed and was unable to be redirected. The record lacked a physician's order the the enclosure bed restraint type.

3. A telephone interview was conducted with the Registered Nurse (E#2) on 9/6/2023, at approximately 1:45 PM. E#2 stated that the Resident/Physician was called and discussed about the need for restraint for Pt. #1. E#2 stated that the physician verbally agreed to a posey/enclosure bed. E#2 stated that the once the resident/physician places an order for restraints in the system, the nurse verifies and acknowledges the order. E#2 stated that E#2 was not aware that the restraint order placed in Pt. #1's record was for side rails up x4 instead of the posey bed, and stated that the order should match the restraint type used.

4. An interview was conducted with the Internal Medicine Resident (MD#2) on 9/6/2023, at approximately 1:00 PM. MD#2 stated that MD#2 was called for the rapid response for Pt. #1 and did not recall placing the order for restraints for this patient. MD#2 stated that a restraint order for a posey bed is different than orders for side rails up x4. MD#2 stated that MD#2 had never placed an order for a posey bed before.