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Based on observations, records reviewed and interview, the Hospital failed to identify hand mitts as a restraint for one of one patient (Patient #47) observed in restraint.
Findings included:

CMS defines a restraint as 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.

The Surveyor observed Patient #47 during medication administration in the Intensive Care Unit at 3:00 P.M. on 10/16/19. Registered Nurse #1 said that Patient #47 had the mitts applied to prevent him/her from removing the naso-gastric tube (an NG tube is passed through the nose and down into the stomach) that was being used to administer both medications and liquid feedings. The mitts were not secured to the mattress or bed and Patient #47 was able to freely move his/her arms. Despite patient effort, the surveyor observed that the patient could not remove the mitts as they were tied around his/her wrists.

The Surveyor obtained a pair of the mitts that were the same as those applied to Patient #47 at 8:25 A.M. on 10/17/19. The Surveyor applied the mitts to herself. The mitts were a thickly padded appliance that would not allow this Surveyor to use her fingers or hands in any meaningful way. The design of these mitts, also known as "boxing gloves" met the definition of a restraint.

The Surveyor observed Patient #47 on the medical-surgical unit that Patient #47 had been transferred to and interviewed the Nurse Manager of the Unit. The Nurse Manager said the mitts did not require a physician's order and were applied as a nursing intervention. The Nurse Manager said that there was no protocol for the use of the mitts (i.e. how often they were removed and reapplied, hand care or checking the circulation, sensation and movement of the hands) and nothing in Patient #47 care plan to address the use of these hand mitts.

Record review indicated there was no assessment for the use of the mitts, and no other interventions used to prevent the patient from removing his /her NG tube before the mitts were applied.