HospitalInspections.org

Based on review of facility documents and staff interview it was determined that the facility failed to include physician and licensed independent practitioner training requirements in their adopted restraint policy.

Findings include:

Review of "IRMC P.C. 147 Subject: Use of Restraints in the non-violent Non-Destructive Patient. Purpose: To provide guidelines for the use of a restraining device to promote medical/surgical care while protecting and preserving the patient's safety, dignity, rights and well-being. Philosophy: Indiana Regional Medical Center strives to limit the use of restraining methods in the delivery of care in these situations with appropriate and adequate clinical justification. The least restrictive restraining device, that meets the patient's assessed need, will always be used. The use of a restraining device for staff convenience, as a means of coercion, or discipline is prohibited. ... Licensed Independent Practitioner: A person who is permitted by both law and the hospital. under his/her license to independently order restraint, seclusion or medication. At Indiana Regional Medical Center LIP's are physicians. Qualified Staff: A staff member who has completed the restraint education program, passed the post-test, and successfully completed the restraint application and removal competency demonstration. ...Staff Education: Education and competency validation for clinical staff will occur at orientation and subsequently, on a periodic basis. Education and competency validation includes: The impact of restraint on patient rights, dignity and specific needs of patient population. Techniques to identify staff and patient behaviors, events and environmental factors that may trigger needs to use restraint or seclusion. Use of non physical intervention skills. Choosing the least restrictive intervention based on the individualized assessment. Safe application and removal of restraints, recognizing signs or physical and psychological distress. Clinical indications that restraints or seclusion are no longer necessary. Monitoring physical and psychological well-being of patient ... " Reviewed May 2010.

1) A review of "IRMC P.C. 147" conducted on June revealed, "Subject: Use of Restraints in the non-violent Non-Destructive" patient. The policy lacked the education and training requirements for physicians.

2) During an interview with EMP3 and EMP4, on June 30, 2010, at 12:25 PM, it was confirmed that "the restraint policy does not address physician education and/or training regarding restraints. EMP3 stated "physician education has not been completed."

3) During a review of Credential Files (CF1, CF2, CF3, CF4, and CF5) on June 29, 2010, it was revealed that five of five CF failed to have documented evidence of restraint education and/or training.

Based on review of facility documents, medical records (MR), and staff interviews (EMP), it was determined that the facility failed to ensure that written orders were timed in 25 of 36 medical records reviewed. (MR1, MR2, MR3, MR4, MR5, MR7, MR8, MR10, MR12, MR17, MR20, MR22, MR23, MR24, MR25, MR26, MR27, MR28, MR29, MR30, MR31, MR32, MR33, MR35, MR36)

Findings include:

Review of "Indiana Regional Medical Center Medical Staff Bylaws Rules and Regulations, Article III Section 3. ... Authentication ... (b) All entries in the medical record shall be dated, timed, and authenticated by the person making the entry. ... Article II Medical Orders Section 3. Verbal Orders (a) A verbal order (either in person or via telephone) for medication or treatment shall be accepted only under circumstances when it is impractical for such order to be given in writing by the responsible Medical Staff member. ... (c) A verbal order shall include the date, time, and full signature of the person to whom the verbal order has been given and shall be countersigned by the prescribing member within 24 hours."

1) During a review of medical records, it was revealed that 25 of 36 records failed to contain dates and/or times for verbal orders.

2) An interview was conducted with EMP2, on June 30, 2010, "do you know of any hospital that does a good job getting physicians to date and time verbal orders."