HospitalInspections.org

Based on interview, record review and a review of facility documentation, the hospital failed to ensure that a restraint was only used when less restrictive interventions had been attempted and found to be ineffective to protect 1 of 5 sampled patients (#1).

Findings:

A review of the medical record of patient #1 was performed. The patient was triaged in the Emergency Department on 8/01/18 at 6:37 AM. Physician orders of 8/01/18 at 10:38 AM read, "Admit patient....Observation status...."

The patient was admitted to 5B Medical/Surgical at least by 11:45 AM on 8/01/18. A nurse's note of 10:10 PM on 8/01/18 read, "Call placed to physician....Dementia pt (patient) s/p (status/post) fall....Keeps trying to get out of bed and leave room. Pls (please) order for posey vest and/or medication to help her sleep." A Posey Vest is a form of physical restraint. There was no evidence in the medical record that any less restrictive interventions had been tried with the patient prior to the request for orders to allow a Posey Vest.

Physician orders of 8/01/18 at 10:08 PM read, "Non violent restraints...Q 2 H....Physician aware of pt behaviors, vest restraint."

A review of hospital policy "Restraint Use in the Acute Care Setting" revealed the following: "Non-violent alternative or de-escalation methods must be attempted prior to the application of the lease restrictive restraint intervention.... When alternative or de-escalation methods have failed, a qualified RN will assess and initiate the least restrictive intervention for prudent safety measures. The patient's behaviors and previous methods attempted must be documented in conjunction with the decision to apply a restraint."

Since there was no evidence in the medical record of attempts at non-violent alternative or de-escalation attempts being made with patient #1 prior to the application of the ordered vest restraint, the facility was in violation of this policy.

During an interview of the Risk Manager on 9/10/18 at 4 PM, she confirmed the finding.