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Based on record reviews and interviews, it was determined that the facility failed to ensure that the continuous use of a restraint was ordered by a physician prior to the continued use of the restraint for two (2) of five (5) patients reviewed (Patient #2R and #3R).

Findings:

The Franklin Community Health Network Restraint Use Policy, updated 8/25/2020, states "Restraints may be used on non-violent, non-destructive patients for purposed medical purposes if clinically justified in the medical record. The order must be time limited and not to exceed 24 hours..."

1. On 8/9/2020 at 6:50 AM, Doctor #1 ordered soft bilateral wrist non-violent restraints for Patient #2R. This order would expire on 8/10/2021 at 6:50 AM per the hospital's policy. There was no evidence that this order was renewed until 8/10/2020 at 7:35 AM, which exceeded the twenty four (24) hours as authorized by the hospital's policy.

2. On 8/9/2021 6:44 AM, Doctor #3 ordered soft bilateral wrist non-violent restraints for Patient #3R. This order would expire on 8/10/2021 at 6:44 AM per the hospital's policy. There was no evidence that this order was renewed until 8/10/2020 at 7:36 AM, which exceeded the twenty four (24) hours as authorized by the hospital's policy.

3. On 8/10/2020 at 7:36 AM, Doctor #3 ordered soft bilateral wrist non-violent restraints for Patient #3R. This order would expire on 8/11/2021 at 7:36 AM per the hospital's policy. There was no evidence that this order was renewed until 8/11/2020 at 8:58 AM, which exceeded the twenty four (24) hours as authorized by the hospital's policy.


On 6/4/2021 at 12:50 PM, two (2) surveyors reviewed the above restraint records with the Nurse in Charge for the Emergency Department. The Nurse confirmed all of the above findings.

Based on document reviews and interview, the facility failed to ensure that restraint training was provided for 1 (one) of 6 (six) staff who was involved with a patient who was in restraints (Registered Nurse #1).

Finding:

The Franklin Community Health Network Restraint Use Policy, updated 8/25/2020, states "All nursing staff in the ICU [Intensive Care Unit], Emergency Department, and the Clinical Coordinators must have education and training at orientation and annually thereafter in the proper and safe use of restraints..."

Documentation in Patient #1R's record indicated the patient was placed in restraints and Registered Nurse ("RN") #1 was involved with the patient and the restraint.

There was no evidence provided by the hospital to indicate RN #1 had completed training on restraints.

On 6/4/2021 at 1:30 PM, the Chief Operating Officer confirmed no evidence could be provided that indicated RN #1 had completed training on restraints.

Based on document reviews and interviews, the hospital failed to ensure documentation related to training and competency for restraints was contained in a staff member's personnel record for 1 (one) of 6 (six) staff who had been involved in a patient restraint (Registered Nurse #1).
Finding:

The Franklin Community Health Network Restraint Use Policy, updated 8/25/2020, states "All nursing staff in the ICU, Emergency Department, and the Clinical Coordinators must have education and training at orientation and annually thereafter in the proper and safe use of restraints..."

Documentation in Patient #1R's record indicated the patient was placed in restraints and Registered Nurse ("RN") #1 was involved with the patient and the restraint.

There was no evidence provided by the hospital to indicate RN #1 had completed training on restraints.

On 6/4/2021 at 1:30 PM, the Chief Operating Officer confirmed that the hospital was unable to show evidence that RN #1 had restraint training documentation in her personnel file.