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Based on observation, interview, and record review the facility failed to protect and promote patient's rights by the lack of personal privacy (See Tag A-143), failed to define "mitts" as a restraint (See Tag A-159), and failed to obtain appropriate physician orders for restraints (See Tag A-168).

Based on observation and interview the facility failed to provide personal privacy by having patient information disclosed for public viewing in the Emergency Department. Findings include:

On 8/26/2010 at approximately 1000 during a tour of the Emergency Department, a physician's laptop computer located on the nurses station counter facing outward into hall and unattended, revealed all the Emergency Department patient's first and last names, age, complaint, and location. This observation was witnessed by staff #H.

On 8/26/10 at approximately 1010 during a tour of the Emergency Department, a large screen display monitor that displays the current patient's in the Emergency Department located near the nurses station, displayed patient's first and last names, age, complaint, and location in the Emergency Department. This screen was able to be viewed by all patients and patient visitors that entered the Emergency Department. This observation was witnessed by staff #H and staff #J.

Based on observation, interview, and record review the facility failed to define "mitts" as a restraint and as a result did not follow the corresponding requirements for restraints for 2 of 2 (#9, #10) patients observed with hand mitts applied. Findings include:

On 8/26/2010 at approximately 1100 during a tour of the Medicine Intensive Care Unit, patient #9 was observed with a hand mitt applied to her right hand and documentation noted in the nurse's notes stated that the mitt was applied between 0700-0730. Staff #N interviewed, when queried about the definition of restraints, staff #N replied "I think they are a restraint because they immobilize the patient's use of her fingers and hand, but our policy defines them as a restraint alternative, so we do not need a physician's order."

On 8/26/10 at approximately 1200 during a tour of 2-South an acute telemetry unit patient #10's medical record was reviewed from a report that patient #10 was wearing hand mitts before from staff #F. It was written in the nurses' notes and assessment that on 8/16/10 at 1500 under section titled "comment:" "no current order for restraints, will try mittens." Staff #E stated "our policy has hand mitts as a restraint alternative."

On 8/26/10 at approximately 1600 during review of the facility's policy and procedure titled "Restraint Usage" on page #7 under the heading "Alternatives to Physical Restraint" under number 1. it is written "Mittens."

Based on record review and interview the facility a) failed to obtain a physician's order, b) failed to have a verbal order authenticated, or c) failed to ensure completion of the physician's orders pertaining to restraints for 6 of 9 (#2, #7, #8, #10, #11, #12) restrained patients. Findings include:

On 8/26/10 between the hours of 0930 and 1230 during a tour of the facility seven of nine medical records were reviewed and found the physician's order for restraints to be without the following:

Patient #2
1)Restraint order dated 8/21/10 is without the authentication of a physician.
2)Restraint order dated 8/23/10 is without the authentication of a physician.

Patient #7
1)Restraint order dated 8/24/10 is without the authentication of a physician and a stop time.

Patient #8
1)Is without a physician's order for restraints between 8/25/10 at 2320 through 8/26/10 2400. This finding was confirmed by Staff #B.

Patient #10
1)Restraint order dated 8/14/10 is without the stop time of a behavioral restraint.
2)Restraint order dated 8/18/10 is without the specification of restraint device type, location, and specification of medical/surgical vs. behavioral along with no start or stop times.

Patient #11
1)Is without a physician's order for restraints on 8/8/10 from 1900 through 2400. A document titled "restraint flow sheet" reveals that patient #11 was in restraints for this time period. This finding was confirmed by Staff #B.

Patient #12
1)Is without a physician's order for restraints on 7/31/10 from 0200 through 0900. A document titled "restraint flow sheet" reveals that patient #12 was in restraints for this time period. This finding was confirmed by Staff #K.