HospitalInspections.org

Based on clinical record review and interview it was determined 1 (Patient #13) of 23 (Patient #1-#23) clinical records did not have an order for a medication that was documented as administered for chemical restraint. Without a physician order to administer the medication, it could not be determined if the medication was used as a standard treatment or dosage for the patient's condition or was used to restrict the patient's behavior. The failed practice affected Patient #13 and had the potential to affect all patients admitted to the facility. The findings were:

A. Review of the clinical record for Patient #13 was performed on 04/30/14. The "Seclusion and Restraint Physician or LIP Order" form for 04/14/14 at 1430 was for seclusion and manual restraint was ordered for up to two hours.

B. Review of the "Seclusion and Restraint RN Progress Note" for 04/14/14 at 1430 revealed "Chemical Restraint: medication given: Thorazine 75 mg IM. The manual restraint time was listed as starting at 1429 and ended at 1430. The seclusion was listed as starting at 1430 and ended at 1505.

C. The "Seclusion and Restraint Face to Face assessment" listed the type of restraint as "Restraint: Manual and Chemical" The medication administered was documented as "Thorazine 75 mg, IM at 1435, as chemical restraint".

D. The Progress record, documented by RN #2 on 04/14/14 at 1530 stated "Pt. received 75 mg IM Thorazine for hypomania. Pt. then went to his room to rest. Will continue to monitor".

E. The findings were confirmed by RN #2 and House Supervisor #1 on 04/30/14 at 1135.

Based on review of policies and procedures, review of clinical records and interview, it was determined the facility failed to assure seclusion time for one (#7) of two (#3 and #7) patients under the age of 9 followed a physician's order. The failed practice did not assure patients under age 9 were not secluded for more than one hour and had the potential to affect all patients on the Children's Unit. Findings follow:

A. Review of the clinical record for Patient #7 with a date of birth 11/22/13, on 04/22/14 revealed seclusion was started at 1951 and stopped at 2137 for a total seclusion time of 1 hour 39 minutes.
B. Review of Physician Order for Patient #7 on 04/22/14 at 1955 revealed, "Seclude up to 1 hour. Not to exceed...under age 9 - 1 hour".
C. Review of Policy, Seclusions revealed, "....provide an order, not to exceed...one (1) hour for youth under age 9".
D. During interview with the Director of Nursing on 05/01/13 at 1000 she confirmed the findings and commented "(named) Children's Unit Registered Nurse #1, failed to get an extension to the order".

Based on review of personnel records and interview, it was determined the facility failed to assure 4 (Psychiatric Technicians #1, #2, #4 and Registered Nurse #4) of 13 (Psychiatric Technicians #1-8, Registered Nurses #1-4 and the Director of Nursing) patient care staff had current TB (tuberculosis) skin testing performed. The failed practice did not assure staff were free from disease and had the potential to affect all patients, visitors and staff in the facility. Findings follow:

A. Review of the personnel records for Psychiatric Technicians #1, #2, #4 and Registered Nurse #4 revealed no evidence of a current TB skin test.

B. Findings were verified with the Director of Human Resources on 05/01/14 at 1315.