HospitalInspections.org

Based on medical record reviews, interview and document review, it was determined that the facility failed to receive orders for a restraint prior to initiation of the restraint in one (1) out of three(3) medical records reviewed.

The findings include:

A log of patients listed as having restraints from July 1, 2024 through to October 15, 2024 was reviewed on 10/15/2024. Patients #8, #9, and #10 were randomly selected from the provided list and their medical records were reviewed with the assistance of Staff Member #1 acting as a navigator

Patient #8 had a non-violent restraint, bedrails, initiated at 2:35 PM on October 13, 2024. The order for that restraint was ordered at 3:35 PM on October 13, 2024.

Staff Member #1 indicated during an interview on October 15, 2024, that when bedrails are being used as a restraint, as they were in this case, orders should be obtained prior to initiation.

A review of the facility's policy entitled, "Restraints/Seclusion, Patient (COG.COG.001)," effective July, 2023, reads in part:
... "5. Order for Restraint or Seclusion
... a. An order for restraint or seclusion must be obtained from a physician or other licensed practitioner....prior to the application of restraint or seclusion."