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Based on medical record review, policy review and interview, the facility failed to ensure orders for restraints were obtained every 24 hours for one (Patient #23) of three medical records reviewed of patients in restraints. The facility's active census was 128 patients and there were a total of three patients in restraints.

Findings include:

Patient #23 was admitted to the facility on 08/05/15 with a diagnosis of chronic alcohol abuse and alcohol withdrawal. A history and physical from 08/05/15 reported Patient #23 was clearly hallucinating. The medical record for Patient #23 contained orders for restraints on 08/06/15 at 4:24 AM, 08/09/15 at 11:289 AM and 08/10/15 at 4:31 PM. The medical record did not contain orders for restraints on 08/07/15 and 08/08/15. The medical record review contained nursing notes on 08/07/15 at 5:54 AM, 7:45 AM and 5:20 PM and on 08/08/15 at 2:22 AM and 7:54 AM which referenced Patient #23 remained in restraints.

The findings were shared with Staff A on 08/11/15 at 2:30 PM and verified. Staff A reported the orders for restraints are not in the medical record from 08/07/15 and 08/08/15.

The facility's Restraint Policy was reviewed. The policy stated orders obtained to address a patient's medical care related needs that are evidenced by non-violent or not destructive behavior are considered to be in full force and effect for up to one calendar day. This includes the day the order was obtained. If the patient remains in restraint for more than one calendar day, then a new order must be obtained. If a restraint is discontinued prior to the expiration to the original order a new order must be obtained prior to reinitiating the use of a restraint.