HospitalInspections.org

Based on document review and interview, it was determined that for 1 of 4 (Pt. #1) sampled records, of patients in seclusion, the Hospital failed to release the patient from seclusion at the earliest possible time.

Findings include:

1. The Hospital's policy titled, "Restraints and Seclusion" (rev. 9/14/17) required, "Procedure: A. Use of Restraints...9. Restraint use is minimized and removed at the earliest possible time when the patient's behavior assessment determines the need for restraint or seclusion is no longer needed or that the patient's need can be addressed using less restrictive methods."

2. The clinical record for Pt. #1 was reviewed on 4/3/18. Pt. #1 was a 14 year old male who presented to the Emergency Department (ED) via ambulance, on 2/23/18 at 9:52 PM, with a complaint of suicide ideation with a plan to hang himself. The clinical record contained orders for seclusion, the first one on 2/23/18 at 10:00 PM, indicating unlocked seclusion. The other orders for restraints were for locked seclusion on: 2/24/18 at 0000 hours (midnight); and 2/24/18 at 2:00 AM, 4:00 AM, 6:00 AM, and 8:00 AM, for "imminent risk of harm to self and others." The "Restraint Monitoring" form (documents patient status/behavior every 15 minutes while in seclusion), dated 2/24/18, from 1:30 AM to 7:15 AM indicated: "psychological status - Quiet; Sleeping." Pt. #1 remained in seclusion while asleep for over 5 hours.

3. The above findings were discussed with the Manager of Patient Care -ED (E #8) during an interview on 4/4/18. E #8 stated, "Patients in these populations can be unpredictable and can go from quiet and sleeping to being combative or leaving, and the locked room was chosen."

Based on document review and interview it was determined for 2 of 4 (Pt. #1 and #9) sampled records, for patients in seclusion, the Hospital failed to ensure face-to-face patient evaluations were conducted for patients in seclusion.

Findings include:

1. The clinical record for Pt. #1 was reviewed on 4/3/18. Pt. #1 was a 14 year old male who presented to the Emergency Department (ED) via ambulance, on 2/23/18 at 9:52 PM, with a complaint of suicide ideation with a plan to hang himself. The clinical record contained physician's orders for seclusion on 2/23/18 at 10:00 PM, and on 2/24/18 at 0000 hours (midnight); 2:00 AM, 4:00 AM, 6:00 AM, and 8:00 AM for "imminent risk of harm to self and others". There was no documentation noted of one hour face-to-face evaluations for the patient.

2. The clinical record for Pt. #9 was reviewed on 4/4/18. Pt. #9 was a 21 year old male, who was presented to the ED by the patient's family on 3/28/18 for combative behavior. The clinical record contained physician's orders for 4 points (2 ankles and 2 wrists), hard restraint on 3/28/18 at 8:43 PM, then seclusion at 10:56 PM. On 3/29/18, seclusion was ordered at 12:47 AM, 4:52 AM, 9:03 AM, 12:19 PM, and 4:20 PM. The record did not include documentation of one hour face-to-face evaluations of the patient.

3. The Hospital's policy titled, "Restraints and Seclusion" (rev 9/14/17) required, "A physician, LIP or privileged physician assistant or advanced practice nurse sees the patient in person and evaluates the need for behavior restraint with one hour of the restraint being initiated. a. The evaluation is in person...b. The assessment included the following: -evaluation of the patient's immediate situation; patient's reaction to the intervention; patient's medical and behavioral condition; need to continue or terminate restraint or seclusion."

4. The Nurse Educator (E #7) for the ED was interviewed on 4/3/18 at approximately 11:40 AM. E #7 stated that every time there is an order for restraint or seclusion a face-to-face evaluation of the patient is conducted.