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Based on policy review, medical record review, and staff interview, the facility failed to ensure restraints were used in accordance with a physician's order for four of four restraint records reviewed (Patient #3, #6, #7, and #8). A total of ten medical records were reviewed. The facility census was 530.

Findings include:

Review of the policy titled, "A104 Restraints and Seclusion - Acute Care," revised 04/05/22, revealed prior to restraint application, an order must be obtained from the physician. In an emergency, the nurse may initiate restraints then obtain the order within minutes of restraint application. Orders are valid for the duration of the episode of care or until the reason for restraint no longer exists. Obtain a new order if the restraints are removed and later the patient has a change in condition that warrants re-application of restraints.

1. Review of the medical record for Patient #3 revealed bilateral soft wrist restraints were applied on 05/25/21 at 9:30 AM and discontinued on 05/26/21 at 12:00 PM. The medical record lacked documentation of any restraint orders. This was verified in an interview on 06/22/22 at 1:45 PM by Staff B.

2. Review of the medical record for Patient #6 revealed bilateral soft wrist restraints and bilateral mitts were applied on 06/15/22 at 4:00 PM. The bilateral soft wrist restraints were discontinued on 06/18/22 at 4:00 PM, and the bilateral mitts were discontinued on 06/18/22 at 10:00 PM. The only restraint order in the medical record was dated 06/17/22 at 7:25 AM for bilateral soft wrist and bilateral mitt restraints. This was verified in an interview on 06/22/22 at 1:00 PM by Staff B.

3. Review of the medical record for Patient #7 revealed bilateral soft wrist restraints were applied on 06/21/22 at 1:00 PM and discontinued on 06/21/22 at 4:50 PM. The restraint order for bilateral soft wrists was obtained on 06/22/22 at 6:45 AM but noted to start on 06/21/22 at 1:00 PM. This was verified in an interview on 06/22/22 at 1:00 PM by Staff B.

4. Review of the medical record for Patient #8 revealed bilateral soft wrist restraints were applied on 06/16/22 at 12:00 PM and discontinued on 06/17/22 at 2:46 AM. The first restraint order was dated 06/16/22 at 6:44 PM for bilateral soft wrist restraints, six hours and 44 minutes after restraint application. The medical record documented bilateral soft wrist restraints were re-applied on 06/17/22 at 8:00 AM and discontinued on 06/20/22 at 6:00 PM. The second restraint order was dated 06/17/22 at 6:35 AM for bilateral soft wrist restraints, an hour and 25 minutes prior to restraint application. A third restraint order for bilateral soft wrist restraints was dated 06/19/22 at 7:42 AM, the day prior to the restraints being discontinued on 06/20/22. The medical record documented bilateral soft wrist restraints were re-applied on 06/20/22 at 7:00 PM. The medical record lacked documentation of any restraint orders on 06/20/22. This was verified in an interview on 06/22/22 at 1:00 PM by Staff B.