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Based on a review of facility documents, medical record (MR) and interview with facility staff (EMP), it was determined that Penn Highlands Tyrone failed to follow their adopted restraint policy by failing to follow the physician's order for the type of restraint, and by failing to obtain a new order for restraint after 24 hours, thus restraining the patient without an order in one of one medical record (MR6).

Findings Include:

Review of Penn Highlands Tyrone ... PolicyStat ID: 7782350 ... Policy Area: Medical Surgical/ICU ... Restraints/Safety Devices dated April 2020. "Purpose: To provide guidelines for the use of physical and/or chemical restraints to protect a patient from injury to himself/herself or to other and to prevent imminent and probable disruption of the therapeutic environment. ... Procedure: I. General Information: A. Patient Rights: 1. Tyrone Hospital recognizes that all patients have the right to considerate, respectful care at all times, with recognition of their personal safety, dignity, and well-being. This includes personal hygiene, daily bathing and recognition as an individual. If restrained, the patient will be able to continue care and participate in care decisions, their environment will be kept safe, clean and appropriate temperature and the patient's need for privacy, modesty and comfort will be respected. ... 3. The dignity of the individual will always be maintained and restraint is not to be used in a manner that causes undue physical discomfort, harm or pain to the patient. Early release from restraint is encouraged. 4. The age, physical and mental condition of the patient will be considered when using and/or selecting the type of restraint. ... B. Definition ... 3. Types of restraints which may be used include: A. Physical-vest (jacket), limb (wrist/ankle), waist, tied-mitts and 4 rails/full siderails. ... 4. The decision as to whether a device is a restraint should be based on the particular purpose for which the restraint is used rather than solely on the type of the device. ... II. Medical Surgical Justification for Restraint Use-must meet a clinical need. ... C. Physician Order-no prn orders permitted. A physician order must be obtained as soon as possible for all patients in which restraints are deemed necessary. The order shall include: 1. Time limited-indicates how long may use, not to exceed 24 hours 2. Reassessed by physician to determine a continuing need for restraint at least once each calendar day 3. Reason for restraint 4. Type of restraint ... ."

Review of Penn Highlands Tyrone ... PolicyStat ID: 8097666 ... Policy Area: Case Management/Utilization ... Patient Rights & Responsibilities dated June 2020. "Rights: The patient has the right to respectful care, given by competent personnel, which reflects consideration of his/her personal value and belief systems and which optimizes his/her comfort and quality. ... The patient has the right to quality care and high professional standards that are continually maintained and are reviewed. The patient has the right to expect good management techniques to be implemented within the hospital considering effective use of your time and to avoid your personal discomfort. ... The patient has the right to be free from any restraints-both physical and drug-that is not medically necessary or is used as a means of coercion, discipline, convenience or retaliation by staff. ... ."

1. MR6 physician order revealed, "... Restraint Order: December 13 @ 0252 ... Start 0252 ... Episode Description: Initial Episode. Clinical Justification: Prevent Injury to Self. Less Restrictive Alternatives: 1:1 Communicator. Type of Restraint Ordered: 2 Side Rails."

2. MR6 nursing documentation dated began on December 13, 2020 at 4:00 AM revealed, "... Type of Restraint: Soft Limb. Ext Restrained (if applicable) Bilateral Hands ... ."
MR6 nursing documentation every two hours revealed bilateral soft limb (wrist) restraints were utilized to prevent removal of ETT and pulling at lines, until they were removed on December 14, 2020, at 12:00 PM.

3. MR6 failed to reveal a physician order for restraints 24 hours following the initial order on December 13, 2020, at 2:52 AM.
Interview with EMP1 confirmed the above and stated that the restraints that were used were limb restraints not side rails and that there was no new order for restraints to continue after 24 hours.