HospitalInspections.org

43881

Based on policy review, record review, and staff interview, it has been determined that the hospital failed to follow its own policy relative to the assessments conducted while a patient is restrained or secluded for 3 of 4 patients reviewed, Patient ID #s 1, 2, and 3.

Findings are as follows:

According to the hospital's policy titled, restraint and seclusion effective 9/17/2019 states in part,

I. Purpose. The purpose of this Restraint and Seclusion policy (this "policy") is to assure the safety of patients and staff, and to ensure compliance with all applicable regulations, when restraint and seclusion become necessary during patient care...

IV...Seclusion:

The placement of an individual alone for any period of time in a hazard free room or other area from which egress is prevented.

Restraint:
...A physical restraint is any manual method, or a mechanical device, material or equipment attached or adjacent to the patient's body that he or she cannot easily remove and that restricts freedom of movement or normal access to one's body...

V. Procedure...

10) Patients in restraint and/or seclusion are assessed by a trained member of the nursing staff at initiation of the seclusion and/or restraint, at least every 15 minutes thereafter, and whenever staff deems that clinical circumstances warrant. This assessment, which must be documented in the patient's medical record, includes, as appropriate to the type of restraint and/or seclusion: signs of any injury associated with applying the restraint and/or seclusion; nutrition and hydration; circulation and range of motion in the extremities; respiratory and circulatory status, including vital signs; hygiene and elimination; skin integrity; physical and psychological status and comfort..."

During a surveyor observation on 1/31/2023 at 10:41 AM of the transport chair used as a mechanical restraint on the Lippitt 2 Unit with the Director of Nursing, the transport chair consisted of straps which secure the right and left wrists, the right and left ankles, the waist, and shoulders.

1. Record review of a document titled, "Restraint and Seclusion Assessment and Order Sheet" for Patient ID #1 revealed she/he was restrained on 12/15/2022 at 6:50 PM physically via "hands on" and then mechanically via a "transport chair" due to throwing items at staff, attempting to strike and bite staff, and attempting to expose self.

Further review of this document revealed that Patient ID #1 was restrained in a "transport chair" from 6:55 PM until 8:00 PM for a total of 1 hour and 5 minutes.

This "Restraint and Seclusion Assessment and Order Sheet" document failed to reveal evidence that vital signs were obtained every 15 minutes per hospital policy for the duration of the mechanical restraint applied to Patient ID #1 on 12/15/2022. Additionally, this document failed to reveal evidence that the assessments conducted every 15 minutes while the restraint was applied included: nutrition and hydration status, circulation and range of motion in the extremities, respiratory and circulatory status, hygiene and elimination status, and skin integrity status per hospital policy.

2. Record review of a document titled, "Restraint and Seclusion Assessment and Order Sheet" for Patient ID #2 revealed she/he was placed in seclusion on 1/12/2023 at 3:45 PM due to threatening staff and attempting to assault staff ultimately throwing water add staff and running into staff.

Further review of this document revealed that Patient ID #2 was placed in seclusion from 3:45 PM until 4:20 PM for a total of 40 minutes.

This "Restraint and Seclusion Assessment and Order Sheet" document failed to reveal evidence that the assessment conducted every 15 minutes while Patient ID #2 was in seclusion included: nutrition and hydration status, hygiene and elimination status, and skin integrity status per hospital policy.

3. Record review of a document titled, "Restraint and Seclusion Assessment and Order Sheet" for Patient ID #3 revealed she/he was restrained physically on 12/9/2022 at 5:55 PM due to spitting out food and medications, swatting at staff, digging fingernails into staff, and attempting to throw himself/herself onto the floor from a chair.

Further review of this document revealed that Patient ID #3 was held physically by staff from 5:55 PM until 6:35 PM for a total of 40 minutes.

This "Restraint and Seclusion Assessment and Order Sheet" document failed to reveal evidence that the assessments conducted every 15 minutes while Patient ID #3 was physically restrained by staff included: circulation and range of motion in the extremities per hospital policy.

During a surveyor interview on 1/31/2023 with the Director of Nursing Education she acknowledged that vital signs were not documented for Patient ID #1 during the period in which she/he was mechanically restrained on 12/15/2022. Additionally, she agreed that per hospital policy, the above-mentioned components of documentation for restraints and seclusion were missing.

During a surveyor interview on 1/31/2023 at approximately 1:20 PM with the Director of Risk Management, she was unable to provide evidence that vital signs, nutrition and hydration status, circulation and range of motion in the extremities, respiratory and circulatory status, hygiene and elimination status, and skin integrity were documented for Patient ID #1 per hospital policy, nutrition and hydration status, hygiene and elimination status, and skin integrity were documented for Patient ID #2 per hospital policy, and circulation and range of motion in the extremities were documented for Patient ID #3 per hospital policy.