HospitalInspections.org

Based on review of medical records provided to the surveyor, the facility failed to ensure that an order was obtained for each episode of restraint and seclusion. 7 of 10 medical records did not contain the "physician order for restrictive interventions for behaviors." 4 of 10 restrictive interventions for behaviors were not signed or authenticated by a physician.

Findings were
Review of 7 of 10 medical records provided to the surveyor reveal the patients had PRN medications for restrictive interventions.
Patient #1,
1/30/19 2100 aggression/agitation
Haloperidol injectable 5mg/ml 10mg IM
Diphenhydramine injection 50mg/ml 50mg
2/1/19 1227 agitation. Lorazepam injection 2mg/ml, 1mg. Chlorpromazine injectable 25mg/ml 1mg.
Patient #3
2/3/19 0446 psychosis, agitation/self-harm
diphenhydramine injection 50mg, Lorazepam injection 1mg, Haloperidol injectable 10mg.
2/6/19 0600 psychosis. diphenhydramine injection 50mg
Patient #5
2/25/19 1736 severe psychosis. Olanzapine 10mg IM, diphenhydramine injection 50mg.
3/1/19 2300 agitation. diphenhydramine injection 50mg
Patient #7
2/24/19 2252 agitation psychosis. Zyprexa 5mg injection, Benadryl 50mg.
Patient #8
2/12/19 2048 psychosis, agitation/self-harm
Lorazepam injection 2mg, Haloperidol injectable 5mg.
Patient #9
3/23/19 0045 agitation/psychosis. diphenhydramine injection 50mg, Zyprexa 5mg.
3/23/19 1825 psychosis. Haloperidol injectable 5mg, Lorazepam injection 2mg.
3/25/19 1112 Psychosis
Lorazepam injection 1mg, Zyprexa 10mg injection, Diphenhydramine injection 50mg/ml 50mg.
3/25/19 2221 Psychosis, agitation/self-harming
Zyprexa 5mg injection, Diphenhydramine injection 50mg/ml 50mg
3/27/19 0925 agitation
Diphenhydramine injection 50mg/ml 50mg, Lorazepam injection 1mg
3/27/19 1854 agitation
Haloperidol injectable 10mg
3/28/19 2010 agitation/aggression
Haloperidol injectable 10mg
3/29/19 2104 psychosis
Thorazine 50mg injection
3/30/10 2341 psychosis
Haloperidol injectable 10mg
3/31/19 1925 psychosis
Haloperidol injectable 5mg, Diphenhydramine injection 50mg/ml 50mg
4/1/19 2022 agitation/self/harm
Diphenhydramine injection 50mg/ml 50mg, Lorazepam injection 2mg,
Patient #10
12/27/18 0343 agitation/self-harm
Haloperidol injectable 5mg/ml 10mg IM
Lorazepam injection 2mg/ml, 1mg
Diphenhydramine injection 50mg/ml 50mg
12/29/18 0552 psychoses, agitation/self-harm
Haloperidol injectable 10mg/ml 10mg IM
Lorazepam injection 2mg/ml, 2mg Diphenhydramine injection 50mg/ml 50mg
12/30/18 2357. psychoses, agitation/self-harm
Haloperidol injectable 10mg/ml 10mg IM
Lorazepam injection 2mg/ml, 2mg Diphenhydramine injection 50mg/ml 50mg.
1/1/19 1427 psychoses, agitation/self-harm.
Haloperidol injectable 10mg/ml 10mg IM
Lorazepam injection 2mg/ml, 2mg Diphenhydramine injection 50mg/ml 50mg.
1/1/19 0234 psychoses, agitation/self-harm
Haloperidol injectable 10mg/ml 10mg IM
Lorazepam injection 2mg/ml, 2mg Diphenhydramine injection 50mg/ml 50mg.
2/10/19 1608 psychosis, agitation/self-harm
Haloperidol injectable 5mg, diphenhydramine injection 50mg
2/12/19 2048 psychosis, agitation/self-harm
Lorazepam injection 2mg, Haloperidol injectable 5mg.

Physician Orders for Restrictive Interventions for Behaviors forms were not signed by the physician for
Pt #1, 4/8/19.
Pt #4 2/4/19.
Pt #8 2/12/19.
Pt #3 2/2/19. According to the facility procedure purple and yellow forms "Physician Order for Restrictive Interventions for Behaviors. Form No.PBH603-Orders. Physician Order MUST be obtained immediately prior to or at time of initiation."