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Based on record review, policy review, and staff interview, it was determined the facility failed to monitor the condition of restrained patients at intervals determined by the facility's policy for one (#1) of three patients sampled. This practice does not ensure patient need are met.

Findings include:

Patient #1 was admitted on 10/02/09 at 6:11 a.m. with a history of increased shortness of breath and dementia. Review of the physician orders on 10/02/09 at 12:15 p.m. revealed an order for bilateral soft wrist restraints to prevent injury of self and prevent pulling on necessary lines/tubes. Nursing documentation revealed the bilateral soft wrist restraints were placed by a RN (Registered Nurse) at 12:15 p.m.

Facility's policy, "Patient Restraint", last revised 5/09, revealed an RN will assess the patient at least every 2 hours and a trained staff member will monitor each patient in restraint at least 3 times an hour for safety, and to confirm that the patient's rights and dignity are maintained. This check will be documented in either electronic record or on paper..

Review of the clinical record did not show evidence of the RN assessing the patient at least every 2 hours or a trained staff member monitoring the patient at least 3 times an hour.

Interview with the Risk Manager on 7/02/10 at 4:15 p.m. confirmed there was no documentation of restraint monitoring as required by the facility's restraint policy.

Based on record review and staff interview it was determined the facility failed to ensure a Registered Nurse supervised and evaluated the nursing care related to implementing physician orders for one (#1) of three patients sampled. This practice may cause a delay in treatment.

Findings include:

Patient #1 presented to the Emergency Department (ED) on 10/02/09 at 6:11 a.m. for increased shortness of breath.
Review of the ED physician orders revealed laboratory studies that included a complete blood count were to be obtained. The laboratory results were completed at 6:45 a.m. The results revealed the hemoglobin was 7.7 (reference range 12.0-16.0); hematocrit was 23.5(reference range 36.0-48.0); and the red blood cells were low at 2.48 (reference range 4.20-5.40).

Review physician admitting orders at 9:04 a.m. noted an admitting diagnosis of acute CHF (Congestive Heart Failure) and anemia. Physician orders instructed to transfuse 2 units of packed red blood cells and administer Lasix between the units intravenous push.

Review of the laboratory orders revealed the order to Type and Cross (T&C) match at 9:25 a.m. Review of the medical record revealed the patient was transported from the ED to the telemetry unit at 9:30 a.m. Laboratory services collected the patient's blood at 12:40 p.m., over three hours later, for the T&C. The cross match was completed at 2:13 p.m., almost five hours later.

The patient did not receive the 2 units of blood in a timely manner as ordered. Documentation revealed the patient expired on 10/02/09 at 3:30 p.m. There was no documentation for the delay to collect or administer the blood.

Interview with the Risk Manager on 7/02/10 at 4:20 p.m. confirmed the above findings.