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HCA FLORIDA BRANDON HOSPITAL
PATIENT RIGHTS: RESTRAINT OR SECLUSION
Tag No.: A0175
Based on policy, procedure, and clinical record reviews and staff interview it was determined that the facility failed to ensure policies and procedures were developed and implemented related to the monitoring of the restrained patient for 2 (#2, #5) of 6 records reviewed. This practice does not provide for patient safety and ensure patient goals are met.
Findings Include:
1. Patient #2 presented to the Emergency Room on 6/22/10 at 8:21 p.m. with a chief complaint of behavior changes, agitation and hallucinations. Physician order dated 6/23/10 at 6:30 a.m. instructed to place the patient in seclusion. Review of nursing documentation and restraint monitoring logs revealed no evidence of the patient being monitored while in seclusion on 6/24/10.
2. Patient # 5 present to the Emergency Room on 6/27/10 with a chief complaint of attempted suicide and was Baker Acted. On 6/28/10 at 2:30 a.m. the patient was placed in 4 point restraints per physician order. On 6/28/10 at 4:00 am. the restraints were removed. There was no documented evidence on the restraint monitoring at 3:00 a.m., 3:15 a.m. or 3:30 a.m.
The policy and procedure for Patient Restraint and Seclusion was reviewed. The policy and procedure indicated the patient in restraint/seclusion requires a higher level of monitoring.
Interview conducted on 8/31/10 at 12:10 p.m. with the Assistant Chief Nursing Officer revealed that all patients are monitored every 15 minutes when in a restraint. There was no evidence this was reflected in the policy and procedure. Thr interview with the Assistant Chief Nursing Officer (ACNO) confirmed the findings.
PATIENT RIGHTS: RESTRAINT OR SECLUSION
Tag No.: A0187
Based on record review and staff interview it was determined that the facility failed to ensure the justification for the use of restraints was documented for 1 (#6) of 4 sampled patients. This practice could potentially result in an adverse outcome for the patient.
Finding Include:
1. Patient #6's physician order dated 8/22/10 and 8/23/10 instructed for bilateral wrist restraints. The 8/22/10 and 8/23/10 physician orders section for clinical justification for the use of the restraint was not completed.
An interview was conducted on 8/31/10 at 12:10 p.m. with the Assistant Chief Nursing Officer (ACNO) who confirmed the findings.