HospitalInspections.org

Based on document review and interview, it was determined that for 1 of 5 (Pt. #11) clinical records reviewed, the hospital failed to ensure the patient's power of attorney (POA) was informed of the use of non-violent restraints.

Findings include:

1. On 04/11/24, the hospital's policy titled, "Restraints and Seclusion" (revised 11/10/21) was reviewed and required, "A. Patients have the right to be free from restraints ... shall be used in a humane and therapeutic manner ... 2. Restraint for acute medical ... (non-violent) initiated to control behaviors that are non-violent or non-aggressive ... to protect patients from accidental/intentional self-discontinuation of therapeutic interventions (IV lines, drains, catheters ...) when alternative interventions have failed and to promote medical healing ... Responsibilities ... A. Restraint Devices Covered Under This Policy ... b. Soft Wrist Restraints ... Documentation ... 9. Notification of family per patient's consent/request ... Ensure that patient and family are aware of the rationale for the use of restraint devices."

2. On 04/11/24, the hospital's patient pamphlet titled, "Your Rights and Responsibilities as Our Patient" (2021) was reviewed and required, "Involvement of family and friends ... Involve family members and friends in your care when it is safe and possible ..."

3. On 04/11/24, the clinical record of Pt. #11 was reviewed. Pt.#11 presented to the emergency department (ED) on 02/10/24, via ambulance with a chief complaint of coughing and shortness of breath. The clinical record included the following:

-Durable Power of Attorney-Healthcare, scanned 5 pages to the hospital on 02/12/24, and included, "Page 1. (Name of Pt.#11) hereby designate (name of Pt. #1's spouse) ... Page 4, indicated that if spouse is unable or unwilling to act as MPOA (medical power of attorney), a successor will serve as MPOA. There was a total of five names listed as MPOA successors. The list included Pt.#11's son and grandson.

-History and Physical dated 02/10/24 at 9:17 PM, "(Pt.#11) was brought to ED by EMS (emergency medical services) from nursing home ... alert ... able to answer questions ... x-rays show small pleural effusion and questionable pneumonia ... being admitted for further care with cardiology consult.

-Physician's orders dated 02/15/24 at 1:18 AM and 02/15/24 at 5:17 AM, "Non-Violent Restraints. Reason for non-violent restraints: Interference with medical treatment, soft restraint to right and left wrist ... restraints must be removed when an alternative is available and effective and/or patient no longer meets criteria."

-Non-violent Restraint Flowsheets for 02/15/24 through 02/18/24 were reviewed. The flowsheets indicated that on 02/15/24 from 1:00 AM to 1:30 AM, and on 02/15/24 at 4:18 AM, (Pt.#11) was placed on non-violent soft restraints. The clinical record did not include documentation that (Pt.#11's) family or POA was notified that (Pt.#11) was placed on soft restraints due to pulling on IV and oxygen lines. There was no documentation that POA or family members had been made aware that Pt. #11 had been placed on restraints on 2/15/2024.

4. On 04/11/24 at 12:35 PM, an interview was conducted with the Nurse Manager (E#13). E#13 stated that staff are required to notify family when restraints are used.

5. On 04/11/24 at 1:05 PM, an interview was conducted with the Attending Physician (MD#2). MD#2 stated that the family was notified of (Pt.#11) being restrained by (MD#2) when MD#2 spoke to them on the phone. The first conversation was with the son on 02/18/24, and they had about 5 persons on the phone during this conversation.

6. On 04/11/24 at approximately 1:45 PM, an interview was conducted with a Registered Nurse (E#16). E#16 stated that for non-violent restraints, the family should be notified by the staff that applied the restraints even if this occurs in the middle of the night. The family or POA should be notified of any change in condition.