HospitalInspections.org

Based on review of facility documentation, medical record review (MR), facility correspondence and staff interviews (EMP), it was determined that the facility failed to ensure that the use of restraints were in accordance with the order of a physician or other licensed independent practitioner who was authorized to order a restraint by hospital policy in accordance with State law for two of four restraint records reviewed (MR1 and MR2).

Findings include:

Review, at approximately 8:55 AM on June 20, 2019, of PolicyStat ID: 5425250, "Restraint and Seclusion," revised September 2018, revealed, "... Restraint and Seclusion Standard for the Management of Violent/Self Destructive Behavior ... Order and Application 1. When the need for restraint/seclusion is determined, the RN should immediately notify the LIP to obtain an order for restraint. 2. In the case of an emergency, the restraint/seclusion can be initiated by an RN while a stat page is placed to notify the physician of a change in the patient's condition and obtain and order for restraint. ... 5. The time limited order must contain the following elements: a. Date and time restraint/seclusion ordered b. Clinical justification for the application c. Device used d. Time limits ..."

1. Review of MR1 revealed, "... Had to be restrain [sic] by the security officers. Patient was then taken to a room in restraints. ..."

2. Review, between approximately 1:06 PM and 1:17 PM on May 31, 2019, of the facility's internal security footage revealed confirmation that the patient (MR1) was placed in four-point restraints at approximately 6:30 PM on May 16, 2019.

3. Review of MR1 revealed no documentation of an order for four point restraints that were applied at approximately 7:00 PM on May 16, 2019.

EMP1 confirmed this finding on June 5, 2019, at 2:11 PM.

4. Review, at approximately 10:02 AM on June 12, 2019, of MR2 revealed, "... [EMP3] at 12/2/2018 6:30 AM ... At that point, three security guards attempted to subdue [him/her] and during the scuffle patient ended up on the floor on [his/her] back. ..."

5. Review, at approximately 10:46 AM on June 19, 2019, of an email communication from EMP2, received on June 18, 2019, at 4:20 PM, stated, "... [He/She](MR2) was physically held by security ..."

6. Review, at approximately 10:02 AM on June 12, 2019, of MR2 revealed no documentation of an order for the physical hold that the patient was placed in on December 2, 2018, at 6:30 AM.

EMP1 confirmed this finding on July 3, 2019, at 11:07 AM.

Based on review of facility documentation, medical record review (MR), facility correspondence and staff interviews (EMP), it was determined that the facility failed to follow its policy to ensure that the patient was seen face-to-face within 1 hour after the initiation of the intervention for three of three restraint records reviewed (MR1, MR2, and MR4).

Findings include:

Review, at approximately 8:55 AM on June 20, 2019, of PolicyStat ID: 5425250, "Restraint and Seclusion," revised September 2018, revealed, "... Restraint and Seclusion Standard for the Management of Violent/Self Destructive Behavior ... 3. Within one hour after the initiation of the restraint intervention, the LIP, trained RN or physician assistant will perform a face to face patient assessment to evaluate the continued need for restraint. If the LIP is not present at the time of restraint initiation, a face to face patient assessment by the LIP or a specially trained RN/physician assistant is to be performed. The trained RN/physician will consult with the LIP for renewal of restraint or seclusion. The assessment will include: An evaluation of the patient's immediate situation; The patient's reaction to the intervention; The patient's medical and behavioral condition; The need to continue or terminate the restraint or seclusion; The assessment will be documented within the health record. 4. If the patient is released from restraint/seclusion before 1 hr, a face to face assessment by the LIP or trained RN/physician assistant still needs to occur because the event signified a change in a patient condition. ..."

1. Review of MR1 revealed, "... Had to be restrain [sic] by the security officers. Patient was then taken to a room in restraints. ..."

2. Review of MR1 revealed no documentation of a face-to-face evaluation after restraints were applied on May 16, 2019, at approximately 7:00 AM.

EMP1 confirmed this finding on June 5, 2019, at 2:11 PM.

3. Review, at approximately 10:02 AM on June 12, 2019, of MR2 revealed, "... [EMP3] at 12/2/2018 6:30 AM ... At that point, three security guards attempted to subdue [him/her] and during the scuffle patient ended up on the floor on [his/her] back. ..."

4. Review, at approximately 10:03 AM on June 20, 2019, of an email communication from EMP2 stated, "... [He/She](MR2) was physically held by security ..."

5. Review, at approximately 9:00 AM on June 12, 2019, of MR2 revealed no documentation of a face-to-face evaluation after a physical hold was implemented on December 2, 2018, at 6:30 AM.

EMP1 confirmed this finding on July 3, 2019, at 11:07 AM.

6. Review, at approximately 9:00 AM on June 12, 2019, of MR4 revealed, "... patient placed in 4 point restraints for [his/her] and staffs safety. ..."

7. Review, at approximately 11:17 AM on June 12, 2019, of MR4 revealed no documentation of a face-to-face evaluation after restraints were applied on May 22, 2019, at 7:18 PM.

EMP2 confirmed this finding on June 19, 2019, at 4:00 PM.