HospitalInspections.org

Based on review of medical records, policies and procedures and hospital documents, and interviews with hospital staff, the hospital failed to ensure all staff had training and demonstrated knowledge in recognizing all types of restraints that occur and the requirements for restraint application. This occurred in one medical record reviewed (Record #1) where a physical hold restraint was used and in two of six nursing staff (Staff # O and Z) questioned about physical holds.

Findings:

1. On 06/13/12, Patient #1 was physically restrained in a physical hold by security officers after becoming physically and verbally threatening. No physician order for the restraint was obtained and although the physician assistant saw the patient, not evaluation of the restraint was documented.

2. The hospital's restraint policy, entitled Restraint and Seclusion, correctly identified physical holds as a restraint.

3. On 08/21/13, Staff #O and Z told the surveyor that a physical hold/restraint, by itself, did not require a physician's order. Although Staff #O and Z correctly told surveyors that a restraint was anything that restricted the patient's movements,
a. Staff #O stated that a physical hold/restraint was not considered a restraint.
b. Staff #Z, when asked if security holding a patient to calm them down required an order, replied, "No, if there is an immediate thread, it does not require an order."

4. The above findings were reviewed and verified with hospital administrative staff at the time of chart review and staff interview on 08/21/13.

5. Review of the hospital's restraint training did not clearly explain that physical holds required a physician's order, if not used in conjunction to keep the patient safe while mechanical or chemical restraints were being applied/started.

6. Review of the hospital's restraint training did not demonstrate staff were taught that acts of physical aggression, patients striking out at staff, was a behavioral issue; could occur on a medical/surgical or intensive care unit; and the requirements for patient's exhibiting violent behavior needed to be followed, including the within one hour evaluation by a qualified staff member.