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Based on clinical record review and interview, it was determined the Facility failed to update the plan of care for five of five (#2, #3, #8, #12, #13) patients reviewed who were placed in restraints. Failure to include the use of restraints in the plan of care did not reflect a process of assessment, intervention and evaluation by the Interdisciplinary Team when restraints were used and was likely to affect all patients who were restrained. Findings follow:

A. Review of Patient #2's clinical record revealed the Patient was in restraints from 03/11/17 at 0400 to 03/12/17 at 1600. There was no evidence the Patient's plan of care was updated to reflect the use of restraints. Findings were confirmed by the Intensive Care Unit (ICU) Charge Nurse on 05/31/17 at 1321.

B. Review of Patient #3's clinical record revealed the Patient was in restraints from 05/24/17 at 1000 to 05/25/17 at 0800 and from 05/28/17 at 0700 to 05/30/17 at 1100. There was no evidence the Patient's plan of care was updated to reflect the use of restraints. Findings were confirmed by the ICU Charge Nurse on 05/31/17 at 1314.

C. Review of Patient #8's clinical record revealed the Patient was in restraints from 05/28/17 at 0500 to 05/29/17 at 0800. There was no evidence the Patient's plan of care was updated to reflect the use of restraints. Findings were confirmed by the ICU Charge Nurse on 05/31/17 at 1430.

D. Review of Patient #12's clinical record revealed the Patient was in restraints from 03/09/17 at 1900 to 03/12/17 at 0115. There was no evidence the Patient's plan of care was updated to reflect the use of restraints. Findings were confirmed by the ICU Charge Nurse on 05/31/17 at 1452.

E. Review of Patient #13's clinical record revealed the Patient was in restraints from 03/11/17 at 1200 to 03/14/17 at 0900. There was no evidence the Patient's plan of care was updated to reflect the use of restraints. Findings were confirmed by the ICU Charge Nurse on 05/31/17 at 1508.

Based on clinical record review, Policy and Procedure review and interview, it was determined three (#3, #12, #13) of five (#2, #3, #8, #12, #13) Patients were not restrained in accordance with a Physician's order. Failure to obtain a physician's order for restraints did not allow the Physician to be knowledgeable regarding the patient's need for restraints. The failed practice affected Patient #3, #12 and #13 and was likely to affect all patients who were restrained. Findings follow:

A. Review of the policy and procedure for Limb Restraint Application on 05/30/17 at 1425 revealed "1. Physician Order Requirements: Non-violent/Non-Self Destructive patients. Every 24 hours: Physician must evaluate patient for ongoing need for restraints. Every 24 hours: Physician must write order to renew restraints." Implementation: "Obtain a practitioner's order for the restraints."

B. Review of Patient #3's clinical record revealed the Patient was in restraints from 05/24/17 at 1000 to 05/25/17 at 0800 and 05/28/17 at 0700 to 05/30/17 at 1100. During onsite clinical record review on 05/31/17, the Facility could not provide any evidence of a Physician's order for restraints for the dates of 05/24/17 or 05/28/17. Findings were confirmed by the ICU Charge Nurse on 05/31/17 at 1314.

C. Review of Patient #12's clinical record revealed the Patient was in restraints from 03/09/17 at 1900 to 03/12/17 at 0115. During onsite clinical record review on 05/31/17, the Facility could not provide any evidence of a Physician's order for dates of 03/09/17-03/12/17. Findings were confirmed by the ICU Charge Nurse on 05/31/17 at 1452.

D. Review of Patient's #13's clinical record revealed the Patient was in restraints from 03/11/17 at 1200 to 03/14/17 at 0900. During onsite clinical record review on 05/31/17, the Facility could not provide any evidence of a Physician's order for restraints for the dates of 03/11/17-03/14/17. Findings were confirmed by the ICU Charge Nurse on 05/31/17 at 1508.