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Based on policy review and administration interview, the hospital failed to send the required grievance letter in 1 of 3 complaints received, noted in patient #1 ' s complaint.

Failure to send the required grievance response letter to the complainant does not assure the hospital has a complaint resolution process in place that effectively informs complainants about the findings.

Findings:

1. On 02/02/2010, the investigator reviewed the hospital grievance policy.
The review policy was entitled, " Patient Grievance/Complaint Management. "
The administration approved the grievance policy on 12/2008. Review of the policy
reveal that when management completed the hospital ' s internal investigation.
The investigation findings would be provided to the complainant within 30 days.

2. During the interview on 02/02/2010 with the Director of Critical Care. The investigator asked
to review a copy of the grievance response letter sent to the family. The director reported that a grievance response letter was not sent to the family. S/he reported that a telephone call was made on 09/22/2010 to a family member. During the telephone conversation the findings of the investigation were provided.

3. On 02/02/2011, during the investigation a copy of the grievance response letter was available
for review. The hospital failed to send the required grievance response letter to the family member. Also, the hospital failed to follow the written grievance policy.

Based on the policy review and medical records review, the hospital failed to document the patient ' s restraint assessments in 4 of 10 care plans, as noted in P#1, P#2, P#4, & P#5 ' s medical records.

Failure to document patient ' s restraint assessments on the care plan does not assure that patient ' s care plans will be accurate and current.

Findings:

1. On 02/02/2011, the investigator reviewed the hospital ' s " Restraint " policy. The review revealed the policy was approved on 03/2007 by the administration. The policy read that restraint procedures are to be documented in the patient ' s care plan.
Medical Records Review:

2. On 02/04/2011, the investigator reviewed P#1 ' s medical record. Review of a Critical Care (ICU) RN ' s admission entry documented the patient was 44 years old and was admitted on 08/22/2010 to the ICU. The patient was lethargic, with multiple wounds to the buttocks and had other medical problems. The record continued to reveal that on 08/23/2010 at 1421the patient was intubated, placed on a ventilator, and placed in soft bilateral wrist restraints. On 08/26/2010 the ICU RN entry documented on the nursing assessment sheet that the patient was extubated and released from the wrist restraints.

3. Review of an ICU nurse ' s entry dated 08/26/2010 was documented on the patient ' s care plan.
The documentation determined that nursing had not entered any documentation on the care plan
that addressed when the patient was extubated and released from the restraints.

4. On 02/03/2010 review P#2 ' s medical record documented the 66 year old patient was admitted on 07/29/2010 to the geropsychiatric unit. The patient was treated for dementia and posttraumatic stress disorder. On 08/09/2010 the patient was transfer to the PCU (Progressive Critical Unit) for management of urinary tract infection and worsening chronic renal failure.

5. Review of the PCU RN ' s documentation determined that an entry on 08/11/2010 at 0355 was made on the nursing assessment sheet. The documentation described that the patient became agitated and went into respiratory failure. The RN contacted the Code Team and immediately conducted a code.
The patient was intubated, placed on ventilator, placed in bilateral wrist restraints and was moved to the ICU.

6. Review of this patient ' s nursing care plan dated 08/11/2010. It determined that nursing failed to document when the patient was placed in the bilateral wrist restraints. The nursing care plan restraint documentation noted the restraints were applied on 08/12/2010 at 1749. This entry was made 14 hours after the patient ' s initial bilateral wrist restraints were placed.

7. During the review on 02/02/2011 regarding P#4 ' s medical record. The RN documented the 91 year old patient was admitted on 10/23/2010 to the medical unit. Review of the nursing assessment documentation revealed on 11/02/2010 at 2339 the patient was intubated, placed on the ventilator support and soft bilateral wrist restraints were applied. On 11/04/2010 the nursing documentation noted that patient was released from the bilateral soft wrist restraints. Review of the patient ' s care plan revealed the patient was still in restraints on 11/04/2010.

8. During the review of P#5 ' s medical record the nurse made an entry that documented the patient was 76 years old and was admitted on 01/04/2011at 2345 for the management of low potassium levels. The review continued to reveal the patient was transferred on 01/07/2011 at 0900 to ICU. While in ICU the patient went into cardiac arrest, was intubated and placed in bilateral wrist restraints.

9. Review of the patient ' s care plan dated 01/07/2011. It determined that nursing failed to document when the patient was initially intubated and was placed in wrist restraints. The first nursing notes entered on the patient ' s care plan documented the patient was restrained on 01/08/2011.

10. The review of the patient medical records determined the RN ' s failed to document patient ' s specific restraint assessments and procedures in the patient ' s care plans. Also, the nursing failed to follow the written restraint policy. Therefore, nursing failed to keep the patient care plans current.

Based on the policy review, administration review and medical records review, the hospital failed to obtain the appropriate physician ' s restraint orders in 2 of 10 records, as noted in P#1 & P#2 ' s medical records.

Failure to obtain the appropriate physician restraint orders does not assure the hospital is in compliance with the required Patient Rights regulations.

Finding:

1. On 02/02/2011, the investigator reviewed the hospital ' s restraint policy. The review of the policy revealed that on 03/2007 the policy was revised by the administration. The policy addressed that physician ' s orders needed to include the date, time, and when the restraint was started and when the restraint ended. The policy identified the physician was to sign off on the restraint orders.

Medical Records Review:

2. Review of P#1 ' s medical record documented the patient was 44 years old and was transported from a nursing home. The nursing entry documented that the patient was admitted on 08/22/2010 at 0200
to the Critical Care Unit (ICU). The patient ' s History and Physical documentation noted the patient was admitted with confusion, chronic renal failure, with deep buttock wounds, with sepsis and with other medical problems.

3. The review of the patient ' s nursing assessment date 08/23/2010 at 1600. It noted the patient was intubated and bilateral wrist restraints were applied to the upper extremities. Review of the physician ' s restraint order determined this initial order was missing in the record. Further review of ICU nursing assessment sheet revealed that patient ' s initial restraint order was written on 08/25/2010 at 0800 and not on 08/23/2010 at 1600.

4. On 02/03/2011, the investigator review P#2 ' s medical record. Review of the physician ' s History and Physical documentation noted the patient was a 66 years old and was admitted to the medical unit. The physician documented that patient ' s diagnoses included dementia, acute renal failure, with urinary tract infection.

5. Review of the nursing assessment noted that on 08/11/2010 at 0830 that a restraint order was obtained by the nurse. Review on 02/03/2010 determined the restraint order was written but it was missing the physician ' s signature.

6. The investigation done on 02/02-04/2011, determined the hospital failed to obtain the appropriate medical restraint orders. Review of these orders did not always include the start times or include the end times on the orders. Also, the staff failed to follow the written " Restraint " policy.