HospitalInspections.org

Based on review of the hospital's grievance process it was determined the hospital failed to provide a final resolution letter for 3 of 3 grievance records reviewed.

Grievance #1 was received on 11/19/18 and was documented as resolved on 11/20/18, however, there was no final letter sent to the complainant. Grievance #2 was received on 12/17/18 and was documented to be resolved on 12/27/18 with no final letter. Grievance #3 was received on 2/6/18 and was documented to be resolved on 2/15/19 again with no final letter sent to the complainant.

Based on hospital policy review and review of six open and seven closed medical records it was determined that the hospital failed to follow their policy for obtaining Patient 3's written consent on three separate occasions.

Per hospital policy, "Informed Consent" (2014), under section "Oral Consent," "Oral consent should never be used when a written consent can be obtained" and "The hospital requires that an oral informed consent be witnessed by two individuals and oral consent should be noted in the patient's medical record by the physician along with the witnesses".

Patient 3 presented the Emergency Department (ED) in late January with complaints of a headache, dizziness and fatigue. Per the medical record, patient was alert and oriented x 3 (person, place, time).

Further review of the medical record revealed three separate forms, Consent for Treatment, Important Message from Medicare (IM) and the Medicare Outpatient Observation Notice (MOON) that were stamped "Verbal Consent". The Consent for Treatment was not dated, timed and had no signatures from either staff or witnesses. The IM did not have signatures from either staff or witnesses and the MOON had only one staff member signature.

Furthermore, the medical record failed to show documentation of a physician's note regarding any reason the patient could not sign the consents.

The facility failed to follow their policy specific to obtaining a patient's written/signed consent therefore there is not sufficient evidence that this patient was appropriately informed of care or understood the information presented. In addition, using a stamp that says "Verbal Consent" without indicating who gained consent from the patient leaves the hospital unable to follow up with a staff person should questions about the consent arise.

Based on review of 6 open and 7 closed medical records, including two restraint records, it was determined the hospital failed to release a patient from restraints at the earliest possible time for patient #2 and included inappropriate criterion for the cessation of patient #2's restraint episode.

Patient #2 was a 20+ year old patient who presented to the hospital's emergency department (ED) via ambulance for intoxication and threatening behavior. While in the ED, Pt #2 became violent towards staff and was placed in 4-point (limb) violent restraints at 0500. Review of restraint documentation titled "Violent Restraint Flow Sheet" revealed Pt#2 was in restraints for about 2.5 hours. The restraint flow sheet documentation for Pt #2 did not include a description of behaviors that indicated the need for continued restraint. Starting at 0530, patient #2 was documented to be calm for the next two hours. As a result, Pt #2 was not released from restraints at the earliest possible time.

On the flow sheet, titled "Evaluation of Termination" the "Behavioral criteria met for termination" was checked off to be: "Calm" and "No danger to self/others." The only reasonable behavior indicating that restraints for violent beahavior should be released is "No danger to self/others." Continuing restraints until the patient is calm may have led to unneccesary time in restraints.--especially since patient #2 was kept in retraints for two hours past the point at which Patient #2's behavior was described as calm.

(this tag was cited in July 2018)

Based on review of 6 open and 7 closed medical records, inclusive of two restraint records, it was determined that the medical and nursing staff failed to obtain an order as soon as possible after a violent restraint episode was initiated for patient #2.

Patient #2 was a 20+ year old patient who presented to the hospital's emergency department (ED) via ambulance for intoxication and threatening behavior. While in the ED, Pt #2 became violent towards staff and was placed in 4-point (limb) violent restraints at 0500. Per restraint order titled "Restraint Violent Patient 18 years and older," the restraint was entered and signed by the provider at 0710, 2 hours and 10 minutes after the restraint was initiated.

Based on review of security personnel job descriptions and training transcripts, it was determined the hospital had failed to give restraint training to their off duty police officers.

Per the job description for "Armed Officer," "Primary Duties and Responsibilities," the first bullet stated that the armed officer "assists with restraining as needed." Review of an armed officer's personnel file and hospital training transcript identified that they had not received restraint training or the de-escalation training program titled CPI (Crisis Prevention Institute) that the other security officers get.

Based on a review of 6 open and 7 closed medical records, including two restraint records, it was determined the hospital failed to continue restraints in a safe manner for patient #2.

Patient #2 was a 20+ year old patient who presented to the hospital's emergency department (ED) via ambulance for intoxication and threatening behavior. While in the ED, Pt #2 became violent towards staff and was placed in 4-point (limb) violent restraints at 0500.

Review of restraint documentation titled "Violent Restraint Flow Sheet" revealed Pt #2 was in restraints for about 2.5 hours and had a "soft release" where one leg was released at 06:00, the other leg and one arm at 06:45 and the last restraint removed at 07:25. This type of release can result in an injury for the patient. Therefore, the hospital failed to discontinue the restraints in a safe manner.