HospitalInspections.org

Based on document review, medical record review and staff interview, the hospital failed to ensure the nursing staff followed hospital policy by updating the restrained patient's plan of care in six (6) of seven (7) restraint medical records (Patient #11, 12, 13, 14, 15, 31) reviewed. This has the potential to negatively impact all restrained patients by not providing an accurate, written care plan for continuity of care. Findings include:

1. Beckley Appalachian Regional Hospital (BARH) policy, Restraint and Seclusion, last revised 1/8/08, states in part "...The use of restraint/seclusion is done in accordance with a written modification to the patient's plan of care. The plan of care should reflect the assessment, and outcome-oriented goal, planned interventions, and responsibility for implementation. The physician orders should be incorporated into the plan of care. After the discontinuation of restraint/seclusion interventions, the patient plan of care should be updated..."

2. Review of the medical record for Patient #11 revealed the patient was ordered and placed in bilateral soft wrist restraints on 8/15/10 and discontinued 8/21/10. There is no documented evidence of restraints being added to the patient's plan of care.

3. Review of the medical record for Patient #12 revealed the patient was ordered and placed in bilateral soft wrist restraints on 7/26/10 and discontinued 7/27/10. There is no documented evidence of restraints being added to the patient's plan of care.

4. Review of the medical record for Patient #13 revealed the patient was ordered and placed in bilateral soft wrist restraints on 9/11/10 and discontinued 9/16/10. There is no documented evidence of restraints being added to the patient's plan of care.

5. Review of the medical record for Patient #14 revealed the patient was ordered and placed in bilateral soft wrist restraints on 8/22/10 and discontinued 8/23/10. There is no documented evidence of restraints being added to the patient's plan of care.

6. Review of the medical record for Patient #15 revealed the patient was ordered and placed in bilateral soft wrist restraints on 1/21/10 and discontinued 1/23/10. There is no documented evidence of restraints being added to the patient's plan of care.

7. Review of the medical record for Patient #31 revealed the patient was ordered and placed in bilateral soft wrist restraints on 10/20/10. There is no documented evidence of restraints being added to the patient's plan of care.

8. The above records were reviewed with the individual Unit Managers in the afternoon on October 20, 2010 and the Unit Managers agreed with the findings.

Based on document review, medical record review and staff interview, the hospital failed to provide an adequate restraint training program for nursing staff as evidenced by eight (8) of ten (10) nursing education records (Nurse #1, 2, 3, 4, 5, 6, 7 and 8) reviewed revealing no updated inservices. This has the potential to negatively impact all patient care by patients being restrained by staff not being competent in: the application of restraints, the care of the restrained patient and appropriate documentation in the medical record. Findings include:

1. Beckley Appalachian Regional Hospital (BARH) policy, Restraint and Seclusion, last updated 1/08/08, states in part "... Training: Staff involved in restraints must have education, training and demonstrated knowledge based on specific needs of the patient population...This training is provided both as part of orientation to new staff and as part of ongoing inservice training for staff that have direct patient care responsibilities..."

2. Review of the education record for Nurse #1 revealed the last documented restraint education was 10/08 during new-hire orientation.

3. Review of the education record for Nurse #2 revealed the last documented restraint education was 09/06 and was a Post-Test only (no return demonstration).

4. Review of the education record for Nurse #3 revealed the last documented restraint education was 09/06 and was a Post-Test only (no return demonstration).

5. Review of the education record for Nurse #4 revealed the last documented restraint education was 03/09.

6. Review of the education record for Nurse #5 revealed the last documented restraint education was 01/08.

7. Review of the education record for Nurse #6 revealed the last documented restraint education was 01/08.

8. Review of the education record for Nurse #7 revealed the last documented restraint education was 01/08.

9. Review of the education record for Nurse #8 revealed the last documented restraint education was 06/09 during new-hire orientation.

10. During an interview with the Community Chief Nursing Officer (CCNO) in the afternoon of 10/20/10, the CCNO reviewed and agreed with the findings. The CCNO stated the restraint/seclusion training is given to all new-hires at orientation but is not part of the annual competency packet. The CCNO then stated the inservice is offered annually but not required.

Based on document review, medical record review and staff interview, it was determined the hospital failed to ensure a post-anesthesia evaluation occurred in four (4) of four (4) out-patient cases reviewed for patients who received anesthesia services (patients #1, 3, 4 and 5). This has the potential to negatively affect the quality of anesthesia care provided to patients when patients are not properly assessed prior to discharge from the hospital after a procedure. Findings include:

1. Review of the record for patient #1 revealed the patient had an outpatient procedure done on 9/1/10 and received monitored anesthesia care (MAC). There was no post-anesthesia note documented prior to the patient's discharge from the hospital on 9/1/10.

2. Review of the record for patient #3 revealed the patient had an outpatient procedure done on 8/26/10 and received MAC. There was no post-anesthesia note documented prior to the patient's discharge from the hospital on 8/26/10.

3. Review of the record for patient #4 revealed the patient had an outpatient procedure done on 9/7/10 and received general anesthesia. There was no post-anesthesia note documented prior to the patient's discharge from the hospital on 9/7/10.

4. Review of the record for patient #5 revealed the patient had an outpatient procedure done on 8/26/10 and received general anesthesia. There was no post-antesthesia note documented prior to the patient's discharge from the hospital 8/26/10.

5. All medical records were reviewed with the Community Chief Nursing Officer (CCNO) in the morning on 10/21/10 and she agreed with the findings.