HospitalInspections.org

Based on medical record review, policy review and staff interview, it was determined that for 1 of 5 patients (Patient #1) in the medical record review sample with orders for restraints, trained staff failed to monitor the patient at appropriate intervals. Findings included:

The hospital policy entitled "Restraints, Guidelines for Use, Non-Violent or Non-Self Destructive Behavior" stated, "...Monitoring...The following will be monitored and documented at 2-hour interval minimum...Safety monitoring checks which includes integrity of restraints, skin integrity...providing range of motion, checking circulation, and sensation of restrained extremities..."

Review of Patient #1's medical record revealed:
1. Restraint orders:
a. Non-violent, Soft Limb, 2 point
- 1/11/19 at 12:06 PM to 1/12/19 at 6:30 AM
b. Non-violent, Soft Limb, 4 point
- 1/12/19 at 6:30 AM to 1/13/19 at 9:49 PM

2. Restraint Monitoring/Assessment Orders:
a. Non-violent, every 2 hours
- 1/11/19 at 12:06 PM to 1/13/19 at 9:49 PM

3. No evidence of 2 hour safety monitoring checks during the following time periods:
- 1/12/19: 3:40 PM to 7:03 PM (3 hours and 23 minutes)
- 1/12/19 at 11:27 PM to 1/13/19 at 6:21 AM (6 hours and 54 minutes)
- 1/13/19: 2:37 PM to 5:22 PM (2 hours and 45 minutes)

These findings were confirmed by Nurse Manager A on 2/27/19 between 9:45 AM and 9:53 AM.

Based on medical record and personnel file review, policy review and staff interview, it was determined that for 1 of 5 restrained patients (Patient #1) in the sample, there was no evidence that the physician who ordered the restraint had knowledge of the hospital policy regarding the use of restraint or seclusion. Findings included:

The hospital policy entitled "Restraints, Guidelines for Use, Non-Violent or Non-Self Destructive Behavior" stated, "...Training and competency...Physicians...will review the policy at time of initial credentialing..."

A. Review of Patient #1's medical record revealed Physician Resident A ordered:
Soft Limb, 4 point Non-violent Restraints on 1/12/19 at 6:30 AM to 1/13/19 at 9:49 PM

This finding was confirmed by Nurse Manager A on 2/26/19 between 12:20 PM and 12:30 PM.

B. Review of employee/personnel files completed on 2/27/19 between 10:00 AM and 10:44 AM revealed no evidence that Physician Resident A reviewed hospital restraint use policies.

This finding was confirmed by Vice President of Patient Safety and Accreditation A on 2/27/19 at 10:44 AM.

Based on medical record review, policy review and staff interview, it was determined that the registered nurse (RN) failed to evaluate the nursing care for 1 of 5 patients (Patient #1) in the medical record review sample. Findings included:

The hospital policy entitled "Medical-Dental Staff Orders" stated, "...The Registered Nurse (RN) will...Evaluate appropriateness and clarity of orders...Follow-up with the ordering provider when orders appear inappropriate or unclear..."

Review of Patient #1's medical record revealed:

1. Physician ordered Restraint Monitoring/Assessment as follows:
a. Non-violent, every 2 hours
- 1/11/19 at 12:06 PM to 1/13/19 at 9:49 PM
b. Non-violent, every 1 hour
- 1/11/19 at 12:06 PM to 1/13/19 at 9:51 PM

The RN failed to clarify the frequency of the Restraint Monitoring/Assessment order.

This finding was confirmed by Nurse Manager A on 2/27/19 between 9:45 AM and 9:53 AM.