HospitalInspections.org

Based on observation, interview and record review the facility failed to ensure that 7 of 8 sampled patients (Patient ID # 7, # 8, 11, 12, 13, 14, and 15) were restrained in accordance with an appropriate order by a physician or other Licensed Independent Practitioner (LIP) per facility policy.

Several orders for restraint were either absent, incomplete, illegible, or not timed.

Findings include:

TX # 00178314
TX # 00178583

Observation on 07-16-13 during initial tour of the facility between 9:15 a.m. and
11:00 a.m. revealed the following patients in restraints:

Patient ID # 7 (third floor): bilateral soft wrist restraints
Patient ID # 8 (ICU): bilateral soft wrist restraints
Patient ID # 9 (ICCU): bilateral soft wrist restraints

All restraints were observed to be appropriately applied.

Record review on 07-17-13 of eight (8) sampled patient records revealed the following issues regarding restraint orders:

In-Patient ID # 7: admitted on 07-06-13; restraints applied 07-12-13. For both orders for restraints on 07/13 and 07/14/13, the time of the order was illegible.

In- Patient ID # 8: admitted on 06-28-13; restraints initially applied 07-11-13. Orders on 07/12 and 07/13 were unsigned by physician/LIP; order on 07/14/13 was not timed; order on 07/15/13 was signed but the top portion of the order was blank (no clinical justification, restraint device, time limit was listed).

Patient ID # 11 (discharged): admitted 03-25-13; nursing notes documented bilateral upper and lower extremity restraints applied in the Emergency Room (ER) at 7:45 p.m.; patient was " agitated and severely restless. " RN Staff ID # 10 was unable to locate an order for restraint in the clinical record.

Patient ID # 12 (discharged): admitted 02-07-13; restraints initially applied on 02-11-13. RN Staff ID # 10 was unable to locate an order for restraint on 02-15-13; nursing documentation showed patient was restrained at this time. The restraint order for 2-12-13 was not timed. RN Staff ID # 10 was unable to locate an order for restraint in the clinical record.

Patient ID # 13 (discharged): admitted on 02-23-13; restraints initially applied in 03-23-13. Nursing documentation revealed the patient was restrained from 3-23-13 to 03-27-13. RN Staff ID # 10 was unable to locate an order for restraint for 03-24-13 in the clinical record. In addition, the restraint order for 03-25-13 was illegible; the order for 03-26-13 was not timed.

Patient ID # 14 (discharged): admitted on 03-08-13. Restraints initially applied on 03-12-13; nursing documentation revealed patient was restrained from 03-12-13 to 03-14-13. RN Staff ID # 10 was unable to locate an order for restraint for 03-13-13 and 03-14-1324-13 in the clinical record. In addition, the restraint order for 03-25-13 was illegible; the order for 03-26-13 was not timed.

Patient ID # 15 (discharged): admitted on 03-12-13. Restraints initially applied on 03-13-13; nursing documentation revealed patient was restrained from 03-12-13 to 03-14-13. RN Staff ID # 10 was unable to locate an order for restraint for 03-14-13.

Interview on 07-17-13 at 2: 30 p.m. with RN Staff ID # 10 she stated that orders for restraints must be timed-limited to 24 hours and that all restraint orders must be dated and timed. The order must also include the type of restraint, clinical justification, and criteria for release.

Record review of facility policy titled " Restraint and Seclusion Guidance Policy, revised 08/2011, read: " ...5. An order for restraint ...must be obtained from an LIP/physician who is responsible for the care of the patient prior to the application of restraint ...The order must specify clinical justification for the restraint ...the date and time ordered, the duration of use, the type of restraint and ..criteria for release ...Order for ' Restraint with Non-Violent, Non Self-Destructive Behavior: duration of order must not exceed 24 hours ... "