HospitalInspections.org

Based on record review and interview the facility failed to obtain a timely order per facility policy for the use of restraints in 1 of 10 medical records reviewed. (Patient #1)

Findings include:

Review of facility policy "HSHS Restraint and Seclusion Policy" last revised 6/7/18 revealed, in part, under "VI. Restraint Procedure B. Non-violent or Non-Self Destructive Restraints 4. An order is obtained from a physician or LIP (licensed independent practitioner) who is responsible for the patient as soon as the situation that warranted application of restraint(s) is stabilized."

Review of Patient #1's medical record on 11/3/2020 revealed a "Nursing Note" on 10/22/2020 at 1:00 PM, "chest restraint applied along with wrist restraints." Behavior described as, "agitated, restless, confused." Medical record revealed a "verbal order with read back for chest and wrist restraints" written on 10/22/2020 at 8:06 PM. Seven hours after the restraints were applied.

Patient #1's medical record revealed a provider note on 10/23/2020 at 1:55 PM, "ok to transfer to floor with fail [sic] bed. (a 'veil' or 'Net' Bed is a metal frame that sits on the floor completely enclosing a hospital bed with a nylon net canopy that encloses the patient and the mattress.)" Record revealed Patient #1 was transferred to a medical floor on 10/23/2020 "in a Net Bed with wrist restraints." There was no order in the medical record for the Net Bed. The medical record revealed a "Nursing Note" on 10/24/2020 at 3:00 PM, "Patient removed from enclosure bed."

In an interview with Manager D on 11/3/2020 at 12:45 PM when asked about the missing restraint orders, Manager D replied, "I saw that too, we are working on that and the new audit process will help us catch these in real time."

Based on interview and record review the facility failed to ensure restraint orders are not used as a standing order per facility policy for 1 of 10 medical records reviewed of patients who had restraints (Patient #1).

Findings include:

Review of facility policy "HSHS Restraint and Seclusion Policy" last revised 6/7/18 revealed under "V. General Restraint Information A. "... PRN restraint orders or "standing orders" for restraints are not permitted. B. "A trial release constitutes a PRN use of restraints or seclusion and therefore is not permitted. When restraint or seclusion is ended the hospital staff has no authority to reinstitute the intervention without a new order..."

Review of Patient #1's medical record on 11/3/2020 revealed a provider note on 10/26/2020 at 7:18 PM, "place back in veil bed when no staff in room and at hs (hour of sleep or bedtime)." Review of the "Nursing Flowsheet" revealed on 10/26/2020 at 9:30 PM, "patient placed back into enclosure bed."

In an interview with Manager D on 11/3/2020 at 12:45 PM when asked about the Net Bed order, Manager D stated, "it appears we took him (Patient #1) in and out of the Net Bed without getting a new order each time. We are working on education for all staff and providers reminding them of the need to obtain a new order each time."