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Based on review of medical records, documents and staff interviews, it was determined that the Psychiatric Hospital failed to specify the reason for the restraint/seclusion order for six (6) of nine (9) patients (patient #2, 3, 4, 5, 8, 9 and 10) who were restrained/placed in seclusion. This failure creates the potential for the care and condition of all patients placed in restraints/seclusion to be adversely affected.

Findings include:

1. Hospital Policy: Guidelines for Seclusion/Restraint, last reviewed 4/25/12, was reviewed on 4/22/13. It states in part, under Section VIII. Guidelines for Documentation of Seclusion/Restraint: a. Medical Staff, "An order must be written specifying the prescribed treatment, the reason for that order".

2. Medical record of Patient #2 was reviewed on 4/23/13 and revealed, in part, no documented reason for the restraint as part of the order dated 4/11/13.

3. Medical record of Patient #3 was reviewed on 4/23/13 and revealed, in part, no documented reason for the restraint as part of the order dated 3/30/13.

4. Medical record of Patient #4 was reviewed on 4/23/13 and revealed, in part, no documented reason for the restraint as part of the order dated 1/19/13.

5. Medical record of Patient #5 was reviewed on 4/23/13 and revealed, in part, no documented reason for the restraint as part of the order dated 4/3/13.

6. Medical record of Patient #8 was reviewed on 4/24/13 and revealed, in part, no documented reason for the seclusion as part of the order dated 3/5/13.

7. Medical record of Patient #9 was reviewed on 4/24/13 and revealed, in part, no documented reason given for the order for seclusion or the order for mechanical restraints as part of the orders dated 3/1/13.

8. Medical record of Patient #10 was reviewed on 4/24/13 and revealed, in part, no documented reason for the restraint as part of the order dated 3/21/13.

15. These records were reviewed with the Unit 6 Nurse Manager on 4/24/13 at 1050. He agreed with these findings.

Based on review of medical records, documents and staff interview, it was determined that the Psychiatric Hospital failed to provide a face-to-face assessment, with documentation of this assessment, within one (1) hour of notification of a psychiatric emergency requiring restraint/seclusion for one (1) of nine (9) patients (Patient #6) who were ordered restraint/seclusion. This failure creates the potential for the care and condition of all patients ordered restraint/seclusion to be adversely impacted.

Findings include:

1. Hospital Policy Guidelines for: Seclusion/Restraint, last reviewed 4/25/12, was reviewed on 4/22/13. It states in part, under Section VIII. Guideline for documentation of Seclusion/Restraint: a. Medical Staff, "The prescribing medical staff must document in a progress note the face to face examination/evaluation of the patient experiencing the emergency situation as soon as possible and (highlighted) no later than one (1) hour after the notification of the emergency."

2. Medical record of patient #6 was reviewed on 4/24/13. This patient had a documented order for mechanical restraints on 4/16/13 at 2029. The Restraint/Seclusion Record revealed documentation of patient being placed in mechanical restraints at 2035, and release from restraints at 2125. It revealed no documentation of a visit by the physician to the patient's bedside by nursing staff and no progress note documented by the physician of such a visit during the course of this patient's restraint.

3. This record was reviewed and discussed with Unit 6 Nurse Manager on 4/24/13 at 1100. He agreed that the record revealed a lack of documentation of a face-to-face examination/evaluation of the patient by either the nursing staff or by the physician.