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CARILION NEW RIVER VALLEY MEDICAL CENTER
PATIENT RIGHTS: RESTRAINT OR SECLUSION
Tag No.: A0178
Based on interviews and documents review, it was determined the facility staff failed to ensure a patient having restraints in use was evaluated, within the required time limits, by a licensed independent practitioner (LIP) for 1 of 6 patients sampled for restraint use (Patient #3).
The findings include:
The facility staff failed to ensure Patient #3 was evaluated by a LIP with a face-to-face visit within one hour of having restraints documented as being applied for violent and/or self-destructive behaviors.
The following information was found in the facility's policy and procedure entitled, "Restraints, Use of": "LIP (licensed independent practitioner), NP (nurse practitioner), or PA (physician assistant) must see and evaluate the Patient within one hour of initiation of behavioral restraints for violent / self-destructive health purposes and place order in EMR (electronic medical record) for violent restraints."
The following orders were found in Patient #3's clinical documentation:
- Dated 8/19/15 at 12:00AM an order for 'Wrist restraints' for a duration of 4 hours with a reason documented as 'VIOLENT' due to being an 'Imminent danger to self' and an 'Imminent danger to others'.
- Dated 8/19/15 at 4:13AM an order for 'Wrist restraints' for a duration of 4 hours with a reason documented as 'VIOLENT' due to being an 'Imminent danger to self' and an 'Imminent danger to others'.
- Dated 8/19/15 at 8:10AM an order for 'Wrist restraints' for a duration of 4 hours with a reason documented as 'VIOLENT' due to being an 'Imminent danger to self' and an 'Imminent danger to others'.
Patient #3's clinical record did not include evidence of the patient being assessed / evaluated by a LIP, NP, or PA within 1-hour of the initiation of restraints for violent actions.
The absence of a LIP, NP, or PA assessment / evaluation within 1-hour of the aforementioned application of restraints for violent actions was discussed with the facility's Director of Quality and Patient Safety for a final time on the afternoon of 9/3/15; no additional information was provided to the survey team.