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Based on hospital policy review, medical record review, and staff interview, facility staff failed to monitor a patient per hospital policy in 1 of 2 patients requiring behavioral restraints (Patient #5).

Findings included:

Review of hospital policy titled, "Restraint" effective date: 01/13/2014, "...Behavioral Restraints... Patient Monitoring ... At least every 15 minutes, the monitoring should include: -signs of injury associated with applying restraint -skin integrity -Nutrition/hydration -Circulation -and range of motion in the extremities -vital signs -Hygiene and elimination -Physical and psychological status and comfort -Readiness of discontinuation ..."

Medical record review conducted on 01/31/2018 revealed Patient #5 was a 26-year-old female who presented to the hospital's emergency department (ED) on 07/04/2017 at 2326 under involuntary commitment, noting "Severely Aggressive" and "Destructive" Behavior. Patient #5, under the care of Registered Nurse (RN) #1 was placed in bilateral arm restraints on 07/05/2017 at 1615. Review revealed no evidence of monitoring of noted assessment findings at the following times: 1630 - nutrition/hydration, circulation, range of motion in the extremities, hygiene and elimination, physical and psychological status and comfort, and readiness of discontinuation; 1645, 1700, and 1715 - vital signs, nutrition/hydration, range of motion in the extremities, hygiene and elimination, physical and psychological status and comfort, and readiness of discontinuation; 1730 - nutrition/hydration, range of motion in the extremities, hygiene and elimination, physical and psychological status and comfort, and readiness of discontinuation; 1745 - vital signs, nutrition/hydration, range of motion in the extremities, hygiene and elimination, physical and psychological status and comfort, and readiness of discontinuation; 1800 - nutrition/hydration, range of motion in the extremities, hygiene and elimination, physical and psychological status and comfort, and readiness of discontinuation; 1815 - vital signs, nutrition/hydration, range of motion in the extremities, hygiene and elimination, physical and psychological status and comfort, and readiness of discontinuation; 1830 - vital signs; 1845 - vital signs; 1900 - signs of injury associated with applying restraint, skin integrity, nutrition/hydration, circulation, range of motion in the extremities, vital signs, hygiene and elimination, physical and psychological status and comfort, readiness of discontinuation; and 1915 - vital signs. Patient #5 was released from the restraints at 1930.

Interview was conducted on 02/01/2018 at 0815 with RN #1, who vaguely recalled the patient. Interview revealed RN #1 was familiar with the hospital restraint policy. RN #1 acknowledged portions of the restraint assessments were neglected and hospital policy was not followed.

NC00135056