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Based on record review and interview, the facility failed to ensure all patients were free from abuse. The deficient practice is evidenced by the security officer striking a patient in the face in 1 (#3) of 2 (#3, #4) reviewed records where a patient was confronted by a security officer.
Findings:

Review of Operational Standard # OHS.SEC.032, "Code White," issued June 2017, revealed in part, "I. Purpose: This operational standard outlines the process for responding to a security alert or combative person in a manner which considers the safety, security and welfare of patients, visitors, and staff. .. .IV. Procedure: . . .F. Security officers shall utilize non-violent crisis intervention techniques. Staff members in high risk areas, such as security, Emergency Department or psychiatric units shall receive training in non-violent crisis intervention."

Review of Policy # OHS.PTREL.001, "Patient Rights and Responsibilities," effective 11/13/2023, revealed in part, "IV.A.2. - Safe Environment. Every patient has the right to receive care in a safe setting and the right to personal safety (free from mental, physical, sexual, and verbal abuse, or humiliation, neglect, and exploitation)."

Review of the medical record for Patient #3 revealed admission on 08/30/2024. Patient #3 had a history of asthma and was noted to have difficulty breathing while under a Corner's Emergency Certificate at a psychiatric facility. Patient #3 was transferred to the acute care hospital for treatment and was admitted with a diagnosis of hypoxia and schizophrenia.

Review of the orders for Patient #3 revealed the patient was on one to one observation with a sitter.

Review of the incident self- reported to the licensing authority revealed on 08/31/2024 at 9:06 p.m., Patient #3 broke free from his soft restraints and a Code White was called. Patient #3 exited the room, fell, and then tried to enter several patient rooms before entering the restroom in an empty patient room and closing the door. When security opened the door, Patient #3 hit S8SO with a closed fist under the right eye and S8SO delivered defensive counterstrike, contacting the patient's left eye."

In interview on 09/09/2024 at 2:25 p.m., S5SM verified S8SO hit the patient in the face and S8SO received no disciplinary action. S5SM stated, "The security officer was attacked and they have a right to defend themselves as long as they do not become the aggressor."

Based on record review and interview, the facility failed to insure the use of appropriate restraint and seclusion techniques. The deficient practice is evidenced by failure of the hospital to provide documentation a maneuver used by security was a therapeutic hold or met the standard of care for restraint of a spitting patient.
Findings:

Review of Operational Standard # OHS.SEC.032, "Code White," issued June 2017, revealed in part, "I. Purpose: This operational standard outlines the process for responding to a security alert or combative person in a manner which considers the safety, security and welfare of patients, visitors, and staff. .. .IV. Procedure: . . .F. Security officers shall utilize non-violent crisis intervention techniques. Staff members in high risk areas, such as security, Emergency Department or psychiatric units shall receive training in non-violent crisis intervention."

Review of Policy # OHS.PTREL.001, "Patient Rights and Responsibilities," effective 11/13/2023, revealed in part, "IV.A.2. - Safe Environment. Every patient has the right to receive care in a safe setting and the right to personal safety (free from mental, physical, sexual, and verbal abuse, or humiliation, neglect, and exploitation)."


Review of the Safety on Site (SOS) Occurrence Report for the incident on 08/05/2024 revealed in part, "Patient had spit at security guard and then S7SO (security guard) forcefully pushed head away from him and pushed it into the pillow. He went to clean spit off after this and then came back to room with female security guard and appeared to bring his hand down quickly toward the patients face. Patient then began to cry and curled her knees into her body. She had been screaming and her demeanor changed at that moment. I was able to back up and see a more clear view and S7SO's hand was then around the patient's lower jaw, chin, and appeared to be resting firmly on her chest. The female officer said something to him in response to his actions. She had a clear view of the situation and may be able to add to the details of this. The patient continued to repeat the same thing that S7SO had pushed her head into the pillow and then knocked her teeth in. I tried to check her mouth but she wouldn't allow me to."

Review of the security report 08/05/2024 at 1:51 a.m. revealed in part, " On Monday August 5, 2024, at approximately 1:51 a.m., Dispatch contacted security in reference to a patient in room "A" screaming for the police. The call for assistance was from 4B nursing staff.

I, S7SO, along with S9SO arrived on the scene at 1:52 a.m. to hear PEC patient yelling for the police, stating that there were people in her house. Security informs her she in fact is in the hospital and does not believe security. Security attempts multiple times to calm the patient down, to no avail. At this time security is made aware that the patient has been diagnosed as bipolar.

At approximately 2:10 a.m., the patient begins to calm down until the patient begins to kick at staff, nearly striking them on the leg. Security restrained the patient and at that time the patient spat at myself, with saliva coming in contact with my uniform shirt and beard. Security quickly gained control of the patient while medication was administered.

As security was attempting to clear the scene, the patient again began kicking at the air and attempting to swing the TV remote at nursing staff. No one was contacted during the incident as security once again restrained the patient as the nursing staff now were placing 2 point soft restraints on the patient's wrists, as prescribed by the attending physician.

At this time, the patient attempted to spit at security again, but the patient's face was gently guided away, prevented any fluids from being projected.

In interview on 09/09/2024 at 12:30 p.m., S3CRM verified that she had investigated the incident and there were only three people in the room at that time, the nurse and the two security officers. S3CRM verified that the three staff members were interviewed. The nurse who submitted the report had concerns, but stated that the female security officer had a better view than she did. Both the female security officer and male security officer verified the hold on the jaw was properly applied and there was no excessive use of force. S3CRM verified her report of the investigation concluded that proper Crisis Prevention and Intervention (CPI) techniques were used.

On 09/10/2024 at 9:15 a.m., the surveyor requested documentation that the maneuver used to forcefully hold the patient's jaw down to the chest was part of the education provided and standard of care for a spitting patient. S2DQ and S3CRM verified they were not sure if the hold was covered in CPI training.

On 09/10/2024 at 11:25 a.m. S2DQ verified that S5SM had replied to the request for documentation and verified that the maneuver was not part of the formal education and he had no documentation that it was an accepted method or standard of care. S5SM stated the maneuver was part of the hands on training for a biting patient. S2DQ verified the report indicated Patient #4 was spitting at staff not biting.

Based on record review and interview, the facility failed to ensure restraints were performed on the order of a physician. The deficient practice is evidenced by the documented use of restraints without a physician's order in 1 (#4) of 2 (#3, #4) reviewed medical records where restraints were used.
Findings:

Review of Policy # OHS.QUAL.009, "Restraint and Seclusion Use," effective 09/15/2022, revealed in part:
IV. Policy Statement
A.Ochsner recognizes that patients have the right to be free from physical or mental abuse and corporal punishment. . . . .
B.3. A physician order must be obtained for the use of restraints or seclusion. . . .
V. A. . . . Physical holds, specifically the application of force to physically hold a patient, in order to administer a medication against the patient's wishes is considered restraint.

Review of the security report 08/05/2024 at 1:51 a.m. revealed in part, " On Monday August 5, 2024, at approximately 1:51 a.m., Dispatch contacted security in reference to a patient in room "A" screaming for the police. The call for assistance was from 4B nursing staff.

I, S7SO, along with S9SO arrived on the scene at 1:52 a.m. to hear PEC patient yelling for the police, stating that there were people in her house. Security informs her she in fact is in the hospital and does not believe security. Security attempts multiple times to calm the patient down, to no avail. At this time security is made aware that the patient has been diagnosed as bipolar.

At approximately 2:10 a.m., the patient begins to calm down until the patient begins to kick at staff, nearly striking them on the leg. Security restrained the patient and at that time the patient spat at myself, with saliva coming in contact with my uniform shirt and beard. Security quickly gained control of the patient while medication was administered.

As security was attempting to clear the scene, the patient again began kicking at the air and attempting to swing the TV remote at nursing staff. No one was contacted during the incident as security once again restrained the patient as the nursing staff now were placing 2 point soft restraints on the patient's wrists, as prescribed by the attending physician.

At this time, the patient attempted to spit at security again, but the patient's face was gently guided away, prevented any fluids from being projected.

Security cleared the scene at 2:15 a.m. with no further incident. No one was contacted or injured during the incident, and I did not wish to press charges due to the patient's mental state.

At approximately 5:30 a.m., security was called to stand by as nursing staff placed soft restraints on the patient's legs. Security cleared the scene at 5:48 a.m. with no further incident."

Review of the orders for Patient #4 revealed the first orders for restraints on 08/05/2024 were placed at 4:41 a.m., initiated at 4:42 a.m., and discontinued at 5:36 a.m.

In interview on 09/10/2024 at 10:42 a.m., S3CRM verified there was no order for the physical hold performed by security and no order for restraints initiated on 08/05/2024 between 2:00 a.m. and 2:15 a.m.