HospitalInspections.org

Based on interviews and document review, the facility failed to ensure orders were renewed from a physician for physical restraints in 1 of 1 medical records reviewed of patients in the intensive care unit (ICU) with documented use of physical restraints (Patient #4).

Findings include:

Facility policy:

According to Restraints and Seclusion: Violent Patient, a physician order was required to initiate the use of a restraint or seclusion in all inpatient care areas. Orders were renewed by nursing assessment and clinical justification up to 24 hours. Orders were time limited for violent patients depending on the age of the patient. A new order was required every four hours for adults ages 18 years and older.

1. The facility failed to ensure restraint orders were renewed throughout the duration of use of violent physical restraints.

a. Review of Patient #4's medical record revealed Patient #4 was placed in violent four point restraints (physical restraint applied to both wrists and ankles and locked to the bed) on 6/19/19 at 8:15 p.m., due to physically threatening and intimidating nursing staff. Patient #4 remained in the violent four point restraints until 6/20/19 at 8:21 a.m., a period of 12 hours and 6 minutes. An initial provider order for the use of the violent restraints was identified in the medical record dated 6/19/19 at 8:15 p.m. There were no other orders identified throughout the remainder of the 12 hour and 6 minute time period which was in contrast to facility policy which required a new order every four hours.

b. An interview was conducted with Registered Nurse (RN) #3 on 6/27/19 at 11:10 a.m. She stated violent restraint orders had to be reordered every four hours by the provider. RN #3 stated the orders need to be renewed every four hours to reassess the patient's condition and to ensure the continued need of the restraint and the safety of the patient. RN #3 verified it was the responsibility of the nurse who was assigned to care for the patient, to manage and obtain the orders every four hours.

c. An interview was conducted with Manager #13 on 6/27/19 at 8:40 a.m. Manager #13, after review of Patient #4's medical record stated there was only one order identified for violent restraints for Patient #4 over the 12 hour 6 minute time frame. She explained it was uncommon for the ICU to have patients in violent restraints and thus the ordered was not renewed per the policy.