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Based on review of facility documentation, medical records (MR), and staff interview (EMP), it was determined that the facility failed to ensure restraints were in accordance with the order of a physician or other licensed independent practitioner for two of two medical records reviewed (MR1 and MR2).

Findings include:

Review of facility policy and procedure "Restraint and Seclusion Policy" last revised November 18, 2016, revealed "Physician's orders - Non-Behavior A. Restraint is used upon order of a licensed independent practitioner ... E. Orders can NEVER be written as a standing order."

1. Review of MR1 on September 21, 2017, revealed a physician order "August 7, 2017 at 13:45 Restrain patient with Canopy Bed." A Review of nursing documentation for MR1 revealed "August 7, 2017, at 13:45 until 22:44 family present not in use." Further review revealed documentation "22:44 the patient was placed in the Canopy Bed anxious, confused, disoriented, frequent non-purposeful movement, preventing tx care, mobility, attempting to climb out of bed." On August 8, 2017, from 08:45 until 23:20, nursing documentation revealed the canopy bed was not in use until 23:30.

2. Review of MR2 on September 21, 2017, revealed a physician "September 14, 2017, 01:58 Restrain patient with Canopy Bed ... Purpose for restraints: High potential for removing lines, tubes, equipment or dressings." Further review revealed the physician failed to ensure the order included the appropriate condition or symptoms for the type of restraint.

Interview with EMP 3 on September 21, 2017, at approximately 11:30 AM confirmed the above findings and revealed, "No, they should not be using it [the canopy bed] like that."

Based on review of facility policy and procedures and medical records (MR), and staff (EMP), it was determined that the facility failed to document that restraint alternatives or other less restrictive interventions were attempted, prior to the application of physical restraints, for two of two restraint medical records reviewed (MR1 and MR2).

Findings include:

Review of facility policy and procedure "Restraint and Seclusion Policy" last revised November 18, 2016, revealed "Non-Behavioral Restraint - An intervention used only in those situations where there is appropriate clinical justification which directly supports medical healing or treatment other than behavioral reasons. ... Because of the serious consequences of restraints or seclusion such as physical and psychological harm, loss of dignity, violation of patients rights, and even death, emphasis is always placed on the reduction of restraint interventions. Always attempt the least restrictive alternative. ... The following will be included in the documentation of each episode of restraint and seclusion: ... Interventions used and alternatives tried and/or considered; identify least to most restrictive alternatives."

Review of MR1 on September 21, 2017, revealed the the patient was placed in a canopy bed August 7, through August 9, 2017. There was no documented evidence that the least restrictive alternatives were attempted, as per facility policy.

Review of MR2 on September 21, 2017, revealed the patient was placed in a canopy bed on September 14, 2017, and bilateral soft wrist restraints on September 15, 16, and 18, 2017. There was no documented evidence that least restrictive alternatives were attempted, as per facility policy.

Interview with EMP8 on September 22, 2017, at approximately 10:30 AM confirmed the above findings and revealed "I don't see it [documentation that least restrictive alternatives were attempted] either."