HospitalInspections.org

Based on review of facility policy and procedures, review of medical records (MR), and interview with 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 (2) of five (5) restraint medical records reviewed (MR2 and MR4).

Findings include:

Review on May 23, 2017, of the facility policy, "Restraint and Seclusion", dated "10/2015", revealed "I. Policy: Abington Memorial Hospital (AMH) leadership demonstrates commitment to providing competent and compassionate care in an environment that preserves the rights and dignity of its patients and is responsible for creating a culture that supports a patients right to be free from restraint or seclusion ... IV. Restraint for Non-Violent/Non Self-Destructive Behaviors ... 3. The patient is restrained only after alternatives to restraint are considered and/or are determined to be ineffective ... F. Documentation ... 2. The appropriate staff documents the following in the patients medical record ... a. Any alternatives attempted."

Review of MR2, on May 23, 2017, revealed the patient was admitted on May 7, 2016. The patient was placed in bilateral soft limb restraints on May 7, 2016. There was no documented evidence that restraint alternatives, or that other less restrictive interventions were attempted, prior to the application of physical restraints.

Review of MR4, on May 23, 2017, revealed the patient was admitted on May 13, 2016. The patient was placed in bilateral soft limb restraints on May 14, 2016. There was no documented evidence that restraint alternatives, or that other less restrictive interventions were attempted, prior to the application of physical restraints.

Interview with EMP6, on May 23, 2017, between 11:15 A.M. and 11:30 A.M., confirmed that the facilities Emergency Department currently adheres to the facilities policy for the application of restraints. EMP6 further confirmed that restraint alternatives "must be" attempted prior to the application of restraints. EMP6 also confirmed that the medical record "must have" documentation that verifies that restraint alternatives were attempted prior to the application of restraints. EMP6 further confirmed that MR2 and MR4 did not have documented evidence that restraint alternatives, or that other less restrictive interventions, were attempted prior to the application of physical restraints.

Based on review of facility policies / procedures, medical records (MR), and interviews staff (EMP), it was determined that the facility failed to follow it's established policy on the standards for vital sign monitoring of a patient, during/post blood transfusion, on three (3) of five (5) blood transfusion medical records reviewed (MR12, MR13, and MR14).

Findings include:

Review on May 23, 2017, of the facility policy, "Blood/Blood Components-Administration", dated "8/16/2016", revealed "I. Purpose: To provide guideline for the proper administration of blood and blood components ... III. Procedure ... R. Monitor vital signs q. 15 mins x 1, q. 30 mins x 1 and then hourly or more frequently as indicated. Obtain a final set of signs at completion of each unit of blood component ... IV. Documentation ... A. Vital signs as ordered or as indicated."

Review of MR12, on May 23, 2017, revealed, the patient was admitted on May 25, 2016. The patient received a blood transfusion on May 26, 2016. The medical record revealed no documented evidence that the patient's vital signs were accurately monitored, during/post blood transfusion, as required by facility policy.

Review of MR13, on May 23, 2017, revealed, the patient was admitted on May 28, 2016. The patient received a blood transfusion on May 30, 2016. The medical record revealed no documented evidence that the patient's vital signs were accurately monitored, during/post blood transfusion, as required by facility policy.

Review of MR14, on May 23, 2017, revealed, the patient was admitted on May 3, 2016. The medical record revealed the patient received a blood transfusion on July 16, 2016. Further review of the medical record revealed no documented evidence that the patient's vital signs were accurately monitored, during/post blood transfusion, as required by facility policy.

Interview with EMP7, on May 23, 2017, between 9:00 A.M. and 11:00 A.M., confirmed that MR12, MR13, and MR14 did have documented evidence that these patients received blood and/or blood products during their hospitalization. EMP7 further confirmed that MR12, MR13, and MR14 contained no documented evidence that vital signs were accurately monitored, during/post blood transfusion, as required by facility policy.