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Based on observation, interview, and record review the facility failed to obtain a physician's order for physical restraints for three patients (#1, #2 and #3) of four restraint records reviewed at the St. Mary's campus. The facility census was 113 for Cardinal Glennon campus and 307 for St. Mary's campus.
Findings Include:


17865

1. Review of facility policy Restraint Utilization Violent, Self Destructive, undated, showed in part the following:
-vi. When the order to restrain or seclude has been secured by a nurse, the responsible physician must sign the original order with 24 hours .....

2. During an observation on 10/12/10 at 2:55 p.m., patient # 1 was found to be in bed, at rest, mechanically ventilated in bilateral wrist restraints.

Review of the electronic medical record for current patient #1 admitted on 09/27/10 for a gastrointestinal bleed, showed restraint use since 10/11/10. Review of the physician order dated 10/11/10 at 10:00 a.m. showed the order not signed by the physician until 10/12/10 at 11:08 a.m. The time is greater than the twenty-four facility requirement.

3. Review of the electronic medical record for current patient #2 admitted on 09/20/10 for convulsions, showed restraint use periodically since 10/03/10 until 10/12/10. Review of the electronic medical record showed use of bilateral wrist restraints on 10/11/10 at 8:00 p.m. until discontinuation on 10/12/10 at 4:30 a.m. without a physician order.

4. Review of the electronic medical record for discharged patient #3 admitted on 07/09/10 and expired on 09/11/10, showed restraint use from 08/05/10 until 08/06/10. Review of the electronic medical record showed use of bilateral wrist restraints on 08/05/10 at 9:45 p.m. until discontinuation on 08/06/10. The physician did not sign the restraint order until 08/09/10. The time is greater than the twenty-four facility requirement.

Based on policy, record review and interview the facility failed to have a policy documenting the training requirements for physicians in the use of restraint or seclusion. The facility census was 307 patients at the St Mary's campus and 113 patients at the Cardinal Glennon campus.
Findings include:

Review of facility restraint policies showed no policy addressing restraint or seclusion training requirements for physicians.

During an interview on 10/14/10 at 1:30 P.M. Supervisor of the Medical Staff Office, Staff R stated that the facility did not have a policy addressing the training requirements for physicians regarding the use of restraint or seclusion.

Review of Medical Staff files for Staff M, N, and V did not show any training related to the use of restraints or seclusion.