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Based on review of facility policy, medical record (MR), and staff interview (EMP), it was determined nursing failed to implement the established policy for pharmacologic restraint for MR1.

Findings include:

Review on January 21, 2015, of the facility policy "Restraint/seclusion," dated last reviewed May 13, 2014, revealed "Purpose: Geisinger Health System is committed to; 1. Reducing the frequency of restraint use, striving to eliminate the use of restraints. 2. Limiting restraint use by defining the terms restraint, seclusion, and pharmacologic restraint. 3. Using these protective measures in accordance with regulatory standards. Persons Affected: All skill levels of care providers Policy: It is the policy of Geisinger Health System to: 1. Limit the use of restraints/seclusion to protect the immediate physical safety of the patient, staff or others. ... Definitions: ... 3. Pharmacologic restraint is defined as a medication used as a restriction to manage the patient's behavior or restrict the patient's freedom of movement and is not a standard treatment or dosage for the patient's condition. ... Responsibilities: ... Licensed staff are responsible for: Employing less restrictive alternatives to restraint use until deemed unsafe for patient and or staff Obtain order for restraint (RN only) Match order to restraint on patient Adherence to time limited parameters Inform patient/family of discontinuation criteria Monitor and evaluate patient's need for restraint and ADL's [activities of daily living] ..."

Review on January 21, 2015, of MR1 revealed the patient was admitted to the hospital on December 16, 2014 from a skilled nursing facility after having a syncopal episode. The medication reconciliation noted the patient was on Seroquel (an antipsychotic medication) at bedtime at the nursing home. In the hospital, Seroquel was increased to twice a day. The physician ordered Haldol (an antipsychotic medication)1 mg every four hours PRN (as needed) for agitation. Haldol 1 mg. intravenous was administered at 0903 on December 18, 2015. Review of the medication administration record revealed no justification by the nurse for the administration of the Haldol. Review of the nurses' note revealed no documentation of the behavior of the patient at the time of the Haldol intravenous administration.

Interview with EMP1 on January 21, 2015, confirmed there was no documentation in MR1 less restrictive alternatives prior to the administration of the Haldol or documentation of the patient's behavior at the time the Haldol was administered.