Bringing transparency to federal inspections
Tag No.: A0178
Based on the review of 4 open and 8 closed medical records. It was determined that the hospital failed to ensure that all patients placed in violent restraints received a face to face evaluation within 1 hour of restraint initiation. This is true of 2 out of 2 violent restraint medical records reviewed.
Patient #4 and #5 were placed in violent restraints, seclusion, and physical hold to administer medication and the Face to Face was not conducted within one hour of the order.
Patient # 4 is a 20+ year old young adult brought to the ED by Crisis team on an Emergency Petition. Family attempted to bring patient to the hospital and the patient jumped out of a moving car window. The family then called 911. Patient had been agressive and threatening toward staff and family in the ED. An order for violent 4 point restraints was obtained from the psychiatry attending on the day of admission at 22:21. No face to face evaluation was documented for this patient.
Patient #4 was admitted to inpatient behavioral unit. On the following day at 20:31 an order for a physical hold and seclusion was recorded. The face to face was documented the same day at 22:18 almost 2 hours later.
Patient #5 is a 40+ year old adult admitted on an involuntary basis to the behavioral health unit after arriving by ambulance. On the third day of admission patient disrupted milieu by grabing a nurses arm, hit another patient in face and arm and activated the panic button. This event lead to orders for IM medication and restraints at 20:21. Face to face occured at 23:04, almost 3 hours late.
Patient #5 at 05:18 on the forth day of admission was placed in seclusion for being intrusive and violent with other patients and staff. Face to face was conducted at 07:13 on 5/30/2018 making it 2 hours late.