HospitalInspections.org

Based on document review, record review and staff interview it was determined the facility failed to follow their own policy regarding continuation of restraint orders and timely and efficient implementation and communication of physician's orders for restraints. This deficient practice was identified in one (1) of ten (10) records reviewed (patient #10). This failure has the potential to adversely affect the care of all patients.

Findings include:

1. Review of the policy titled "Seclusion and Restraint", last revised 8/17, revealed it states, in part: "Continuation of Orders: After the original order expires, the RN assesses the patient and calls the physician. A new order must be written if restraint or seclusion is going to be continued...Therapeutic Techniques for De-escalation: A patient will be held by a staff member as a means of handling severely disruptive or uncontrolled behavior. Therapeutic holding may also be utilized in escorting a patient to more secure surroundings. Therapeutic holds are physician ordered."

2. Review of the policy titled "Implementation of Physician's Orders", last revised 4/17, revealed it states, in part: "Physician orders will be entered, implemented and communicated by the nursing staff in a timely and efficient manner."

3. A review of the medical record for patient #10 revealed the patient was escorted with resistance at 10:00 a.m. on 1/27/18 and at 10:01 a.m. on 1/27/18 it was documented to release right wrist with relaxation techniques. A review of the physician's orders revealed a restraint order on 1/27/18 at 11:13 a.m. with a start time of 10:00 a.m. and stop time of 10:59 a.m. Further review revealed the patient was noted to be in a therapeutic hold on 2/7/18 at 2:45 p.m. and in five (5) point restraints at 2:55 p.m. A review of the physician's orders revealed a restraint order for therapeutic hold on 2/7/18 at 2:45 p.m. with a start time at 2:45 p.m. and a stop time at 3:14 p.m. A second physician's order for restraints up to one (1) hour on 2/7/18 at 2:55 p.m. with a start time at 2:55 p.m. and stop time at 3:54 p.m. was documented. A third physician's order for restraints up to one (1) hour on 2/7/18 at 3:55 p.m. with a start time at 3:55 p.m. and stop time at 4:54 p.m. was documented. A fourth physician's order for restraints up to two (2) hours was documented on 2/7/18 with a start time at 4:44 p.m. and stop time at 6:44 p.m.; however, this was not documented until 9:26 p.m. There was no significant evidence to indicate the physician was notified and provided orders for the last restraint prior to the patient being restrained for the fourth time. Patient #10 was noted to be in restraints on 2/7/18 from 2:45 p.m. to 5:50 p.m.

4. An interview was conducted with the Director of Quality and Risk Management on 3/28/18 at 10:45 a.m. She concurred with the above findings.