HospitalInspections.org

Based on document review, record review and staff interview it was determined the facility failed to ensure nursing staff followed the Plan of Correction and policy and procedures for restraints. This failure was identified in seven (7) of ten (10) medical records reviewed (patients #1, 2, 4, 5, 6, 8 and 10). This failure has the potential to adversely affect all patients.

Findings include:

1. A review of the policy titled "Restraint Management," effective 1/2020, stated in part: "The Nursing Supervisor will not release restraints to the staff until he/she has verified that: Alternatives to prevent restraints have been attempted and documented...There is a documented physician, clinical psychologist, or other authorized licensed independent practitioner (physician assistant, nurse practitioner) order for the restraint...The Nursing Supervisor has completed the 'second tier review' in Meditech."

2. An interview was conducted with the Chief Nursing Officer (CNO) and Nursing Supervisor on 6/15/20 at 12:55 p.m. The CNO called the Nursing Supervisor to come and talk to the surveyor about the process for a second-tier review. The Nursing Supervisor stated a second-tier review is to verify the alternatives have been completed and a physician order is in the patient's medical record before a patient can be restrained. She stated a second-tier review is not to justify a restraint but to ensure the alternatives and physician order are in the record. She stated the Nursing Supervisor will give restraints to the nurse after the second-tier review is completed. She verified for chemical restraints the Nurse Supervisor is verifying the alternatives were completed and there is a physician's order. She stated, "Physicians will write an order for the nurses to restrain patients if needed." She further stated the physician might write a restraint order at 10:00 a.m. but the patient will not be put in the restraint until 11:00 a.m.

3. A review of the medical record for patient #1 revealed an order for restraints on 3/4/20 at 8:53 p.m.; the alternatives were documented completed at 8:00 p.m. and the second-tier review was documented at 8:05 p.m. Another order for chemical restraints was ordered on 3/5/20 at 12:41 a.m.; the alternatives were documented as completed at 12:35 a.m. and no second-tier review was completed. An order for chemical restraints was documented on 3/5/20 at 4:50 a.m.; the alternatives were documented as completed at 4:45 a.m. and the second-tier review was documented at 4:45 a.m. An order for chemical restraints was documented on 3/5/20 at 8:50 a.m.; the alternatives were documented as completed at 8:45 a.m. and the second-tier was documented at 8:45 a.m. An order for chemical restraints was documented on 3/5/20 at 12:50 p.m.; the alternatives were documented as completed at 12:45 p.m. and the second- tier review was documented at 12:45 p.m. An order for restraints was documented on 3/5/20 at 4:58 p.m.; no description of type of restraint was noted on the order. The alternatives were documented as completed at 3:45 p.m. and the second-tier was documented at 3:45 p.m. An order for restraints was documented on 3/5/20 at 9:08 p.m.; no description of type of restraint was noted on the order. The alternatives were documented as completed at 8:45 p.m. and the second-tier was documented at 8:45 p.m.

4. A review of the medical record for patient #2 revealed an order for restraints on 6/13/20 at 4:34 p.m.; the alternatives were documented as completed at 4:32 p.m. and the second-tier review was documented at 4:32 p.m. Patient #2 was placed in restraints on 6/13/20 at 5:30 p.m.

5. A review of the medical record for patient #4 revealed an order for restraint on 3/19/20 at 11:25 a.m.; the alternatives were documented as completed at 11:25 a.m. with no second-tier review documented. An order for restraints was documented on 6/21/20 at 6:15 a.m.; the alternatives were documented as completed at 6:00 a.m. and the second-tier was documented at 6:00 a.m.

6. A review of the medical record for patient #5 revealed an order for restraints on 5/16/20 at 11:39 p.m.; the alternatives were documented as completed at 11:30 p.m. and the second-tier review was documented at 11:30 p.m.

7. A review of the medical record for patient #6 revealed an order for restraints on 5/6/20 at 1:52 a.m.; the alternatives were documented as completed at 1:10 a.m. and the second-tier was documented at 1:10 a.m.

8. A review of the medical record for patient #8 revealed an order for restraints on 5/5/20 at 8:30 a.m.; the alternatives were documented as completed at 8:10 a.m. and the second-tier was documented at 8:10 a.m.

9. A review of the medical record for patient #10 revealed an order for restraints on 6/13/20 at 8:00 a.m.; the alternatives were documented as completed at 7:45 a.m. and the second-tier was documented at 7:50 a.m.

10. An interview was conducted with the Director of the Surgical Intensive Care Unit and Coronary Care Unit on 6/16/20 at 10:15 a.m. He concurred the second tier reviews were not completed as per policy.