HospitalInspections.org

Based on record review and review of policies and procedures, the hospital failed to follow its policy and procedure for monitoring patients while in restraints for 2 of 7 patient records reviewed (Patients #12, #14).

Failure to follow established procedures for restraints risks physical and psychological harm, loss of dignity, and violation of patient rights.

Findings:

1. The hospital's policy and procedure entitled "Restraints" (Policy Number 8610-R-2; Revised 7/25/2008) stated that staff member who was trained and competent in the application and monitoring of patients in restraints would assess the patient at the initiation of restraint application and every 15 minutes thereafter. The assessment would include monitoring for signs of injury related to the application of the restraint; the status of nutrition and hydration; checks of adequate circulation and need for range of motion of the restrained extremity(ies); physical and psychological discomfort; and the readiness for discontinuation of the restraint. This would be documented in the patient's medical record.

Patients restrained for non-behavioral reasons (i.e. non-violent behaviors) would be assessed at least every two hours, or more frequently according to patient need, and would include the elements described above. Assessment results would be documented in the patient's medical record.

2. Review of the records of seven patients who had been restrained during their hospitalization revealed the following:

a. On 1/10/2011, Patient #14 was admitted to the ED for evaluation of self-destructive behavior related to cocaine abuse. The patient was combative on admission and was placed in 4-point soft restraints at 9:49 PM. The patient remained in restraints until 6:55 AM on 1/11/2011. There was no documentation in the patient's medical record that the patient had been assessed every 15 minutes according to the hospital's restraint policy and procedure.

b.. On 8/6/2011, Patient #12 was admitted to the ED for treatment of acute respiratory failure related to alcohol intoxication. The patient was intubated and placed in 2 point soft upper limb restraints by the ambulance crew to prevent the patient from accidentally removing the endotracheal tube. The patient remained in restraints until 6:45 AM on 8/7/2011. There was no documentation in the patient's medical record that the patient was assessed every two hours according to the hospital's restraint policy and procedure.

Based on record review and review of policies and procedures, the hospital failed to follow its policy and procedure for ordering restraints for management of patients exhibiting violent or self-destructive behavior for 3 of 7 patient records reviewed (Patients #11, #13, #14).

Failure to follow established procedures for restraints risks physical and psychological harm, loss of dignity, and violation of patient rights.

Findings:

1. The hospital's policy and procedure entitled "Restraints" (Policy Number 8610-R-2; Revised 7/25/2008) stated that restraints applied for management of violent or self-destructive behavior would be in accordance with an order given by a physician or Licensed Independent Practitioner who is responsible for the care of the patient and authorized to order the restraint. The order would be renewed every four hours for adults 18 of age and older.

2. Review of the records of seven patients who had been restrained during their hospitalization revealed the following:

a. On 9/4/2011, Patient #11 was admitted to the ED for evaluation of suicidal ideation and assaultive behavior. The patient was placed in 4-point soft restraints at 9:55 PM and remained in restraints until 4:45 AM on 9/5/2011. There was no physician or LIP's order after the first four hours of application to authorize continued use of the restraints.

b. On On 7/5/2011, Patient #13 was admitted to the ED for treatment of methamphetamine toxicity and renal failure. The patient was combative on admission and was placed in 4-point soft restraints at 11:32 PM. The patient remained in restraints until 6:55 AM on 7/6/2011. There was no physician or LIP's order after the first four hours of application to authorize continued use of the restraints.

c. On 1/10/2011, Patient #14 was admitted to the ED for evaluation of self-destructive behavior related to cocaine abuse. The patient was combative on admission and was placed in 4-point soft restraints at 9:49 PM. The patient remained in restraints until 6:55 AM on 1/11/2011. The physician's order authorizing continued use of the restraints did not include the time the order was written.. There was no evidence that the order had been written after the first four hours of restraint application to authorize continued use of the restraints.