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Based on interview and record review, the facility failed to ensure staff followed policy and procedure titled, "Restrain Assessment and Use of Non Violent, Violent and Seclusion," for 1 of 3 patients (Patient 1), who had restraints, when Patient 1's documented type of restraints did not reflect the Physician orders, and there were gaps in every two-hour restraint monitoring. This failure violated Patient 1's right to receive appropriate restraints based on policy and procedure and had a potential for unsafe restraints use.

Restraints- any manual method, physical or mechanical device, material or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body or head freely.

Soft restraints- are devices made of material designed to safely fit around the wrists, ankles, or chest of a patient.

Findings:

During a record review and interview on 10/09/20, at 1:53 p.m., Registered Nurse A verified staff put Soft restraints bilateral (left and right) on Patient 1's wrists on 9/18/20, because he was pulling medical tubes, due to agitation and disorientation. Review of the medical record indicated Patient 1 was admitted to the Inpatient Unit on 9/18/20, with a primary diagnosis of ST-Elevation Myocardial Infarction (STEMI- is a very serious type of heart attack during which one of the heart's major arteries--one of the arteries that supplies oxygen and nutrient-rich blood to the heart muscle--is blocked).

During an interview on 10/09/20, at 3:10 p.m., the Chief Nursing Executive verified the Physician order for restraint duration would be in effect for 24 hours, up to one calendar day, and as an example, the Physician order for restraint on 9/25/20 at 12 p.m., would expire on 9/26/20 at 11:59 p.m.

During a record review and interview on 10/09/20, at 4:33 p.m., Registered Nurse B verified Patient 1 had documented types of restraints and Physician orders for restraints, on the following dates and times:

-On 9/18/20 at 9:30 p.m., Patient 1's Nursing Flowsheets indicated he had Soft restraints bilateral wrist. On 9/18/20 at 9:30 p.m., and 9/19/20 at 6:50 p.m., the Physician orders indicated for Soft restraints bilateral wrist. Patient 1 was on Soft restraints bilateral wrist from 9/18/20 until 9/20/20 at a.m.

- On 9/21/20 at 5:44 p.m., until 9/22/20 at 6 p.m., Patient 1's Nursing Flowsheets indicated he had Soft restraint: Vest/jacket. On 9/21/20 at 5:45 p.m., the Physician order indicated an Enclosure Bed restraint (an enclosure bed is constructed with an over-the-bed frame with zippered mesh walls and a roof covering all four sides of the bed. The bed is used to reduce restraint use, allow free movement within the bed, prevent falls and/or wandering).

-On 9/22/20 at 8 p.m., until 9/29/20 at 6 a.m., Patient 1's Nursing Flowsheets indicated he had Soft restraint: Vest/jacket, which had the corresponding Physician orders for Vest/Jacket restraints, every day, from 9/22/20 at 7:19 p.m., until 9/28/20 at 8:20 a.m.

-On 9/29/20 at 8 a.m., Patient 1's Nursing Flowsheets' shift assessment indicated he had no Soft restraint: Vest/jacket nor bilateral wrist, only all sides of the bed rails were up. There was no documentation when staff discontinued the use of vest/jacket, and there was no documented restraint monitoring between 10 a.m. until 2:50 p.m.

-On 9/29/20 at 2:50 p.m., Patient 1's Nursing Flowsheets indicated he had Soft restraints bilateral wrist. On 9/29/20 at 2:50 p.m., the Physician order indicated vest/jacket restraint and all sides of bed rails up; there was no order for Soft restraints bilateral wrist.

-From 9/29/20 at 2:50 p.m., until 10/03/20 at 12 p.m., Patient 1's Nursing Flowsheets indicated he had Soft restraints bilateral wrist; there was no order for Soft restraints for bilateral wrist. From 9/29/20 at 2:50 p.m., to 10/03/20 at 9:40 a.m., Physician orders indicated restraint: Vest/jacket; there was no Physician order for Soft restraints bilateral wrist. Not until 10/03/20 at 12:28 p.m., a new Physician order indicated for Soft Restraints bilateral wrist.

Review of the policy and procedure titled, "Restrain Assessment and Use of Non Violent, Violent and Seclusion," last reviewed on 10/07/20, indicated the orders must indicate the type of restraint, and the patient is monitored at least every two hours, or sooner, according to patient need.