HospitalInspections.org

Based on review of medical records, policy and procedure and an interview with Employee Identifier (EI) #1, the Chief Nursing Officer, it was determined that the facility:
1. Failed to assure a new order was obtained to reinitiate a restraint for 2 of 3 patients restrained after an early/trial release.

2. Policy for the "Restraints, Use of" is in violation of the regulation.

This affected Medical Record (MR) # 2 and MR # 18.


Findings Include:

Policy: Restraints, Use of
Policy Number: PRN HW 008
Approved: February 2006

Procedure
1. GUIDELINES FOR MEDICAL-SURGICAL RESTRAINTS
SCOPE:
Licensed Independent Practitioner ORDERS
".... Orders clearly specify the reason, type of restraint, and period of time for the use of the restraints ....

.... Should the patient require reapplication of restraints after early release, and the same behavior is still evident; the original order can be reapplied if alternatives are ineffective. The time period of the original order cannot be exceeded when restraints are reapplied ..."


1. Medical Record # 2 was admitted to the hospital 12/9/10 with a diagnosis of Small Bowel Obstruction. On 12/14/10 at 12:01 AM a "Physicians' Order for Review of Restraints for Medical Safety" was written.

Review of the clinical note documented on 12/14/10 at 1:00 AM by the nurse revealed:
"Response to Alternatives: Behavior ceased, successful in resolving problems.
Reason for Early/Trail Release: Pt's (patient's) mental status has improved."

Further review of the clinical note documented on 12/14/10 at 7:00 AM by the nurse revealed:
"Wrist Restraint: Bilat (bilateral)
Wrist Type: Soft
Reason for Restraint: Tx (treatment) interference."

According to the MR, the next order that was written for the restraint use was written on 12/15/10 at 12:01 AM. There was no new order obtained prior to reinitiating the restraint at 7:00 AM on 12/14/10.




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2. Medical Record # 18 was admitted to the hospital 12/9/10 with a diagnosis of Sacral Decubitus Ulcer. Review of the physician's orders revealed a "Physicians' Order for Review of Restraints for Medical Safety" dated 10/09/10 at 0015.

Review of the clinical note dated 10/12/10 at 0630 revealed the nurse documented as follows: "Alternative tried I released restraints".

Further review of the clinical note dated 10/12/10 at 1001 revealed the nurse documented as follows:
"Wrist Restraint: Bilat (bilateral)
Wrist Type: Soft
Reason patient restrained: Tx (treatment) interference."

Further review of the physician's orders revealed there was no order obtained prior to reapplying the restraints at 1001 on 10/12/10. Neither was an order obtained to use restraints on 10/13/10.

The section of the policy for reapplication of restraints after early release is in violation of the regulation.

The regulation states that if restraint or seclusion is discontinued prior to the expiration of the original order, a new order must be obtained prior to reinitiating the use of restraint or seclusion.

An interview conducted 12/16/10 at 11:00 AM with EI #1, the Chief Nursing Officer, confirmed that there were no physician orders for reapplication of restraints after early release and that the facility policy did not meet the regulation.

Based on observations during facility tour with hospital staff by the Fire Safety Compliance Officer and staff interviews, it was determined that the facility was not constructed, arranged and maintained to ensure patient safety.

Findings include:

Refer to Life Safety Code violations.

Based on observations and staff interview, it was determined the facility failed to have a policy to assure the operating rooms were monitored for safe parameters of humidity and temperature for 16 of 16 operating rooms. This had the potential to affect all patients served.

Findings include:

During a tour of the Surgery Department on 12/14/10 at 11:15 AM with Employee Identifier (EI) # 2, Director of Nursing of Surgical Services, the surveyor requested to see documentation of temperature and humidity monitoring for the 16 operating rooms. EI # 2 stated that Engineering monitors and keeps a record of the temperature and humidity of the operating rooms.

During an interview on 12/14/10 at 1:35 PM, EI # 2 was unable to provide any documentation of the temperature and humidity monitoring for the 16 operating rooms. The surveyor requested to see a policy regarding operating room temperature and humidity monitoring guidelines. No policy was provided.