HospitalInspections.org

Based on policy review, medical record review, and interview, the hospital failed to ensure a patient was monitored and re-evaluated by nursing staff to determine the earliest possible time to discontinue restraints for 1 of 3 (Patient #2) sampled patients.

The findings included:

1. Review of the hospital policy "Restraint And Seclusion Policy" revealed, "...Purpose...This facility ensures that restraint and seclusion interventions are safely and appropriately used...A qualified Registered Nurse [RN] must assess the patient at established timeframes...Assessment, as appropriate to the type or [sic] restraint or seclusion...signs of injury associated with the application of restraints or seclusion...nutrition/hydration...circulation and range of motion in the extremities...vital signs...hygiene and elimination...physical and psychological status and comfort...cognitive functioning...readiness for discontinuation of restraint or seclusion...Ongoing monitoring is performed...the physical and emotional well being of the patient...that the patient's rights, dignity and safety are maintained...whether less restrictive methods are possible...changes in the patient's behavior or clinical condition needed to initiate the removal of restraints...whether the restraint has been appropriately applied, removed, or reapplied...Care is provided at least every 2 hours to include...offer of fluids/nourishment...hygiene care as required...toileting as required...release of extremities and range of motion exercises provided..."

2. Medical record review for Patient #2 revealed an admission date of 11/22/2020 with diagnoses which included Altered Mental Status, Aspiration, Influenza B, Pneumonia, and Urinary Tract Infection.

A physician's order dated 12/3/2020 at 2:00 PM revealed an order for soft limb restraints for bilateral upper extremities due to Patient #2 persisting in efforts to disconnect medical equipment. This was the first order for restraints for Patient #2 during the hospital stay.

The "Restraint/Seclusion Flowsheet" dated 12/3/2020 revealed there were no alternative interventions attempted prior to initiation of the restraints documented.

A physician's order dated 12/4/2020 at 2:00 PM revealed an order for soft limb restraints for bilateral upper extremities due to Patient #2 persisting in efforts to disconnect medical equipment.

The "Restraint/Seclusion Flowsheet" dated 12/4/2020 revealed restraint monitoring was documented as performed until 12/5/2020 at 7:00 AM. There was no documentation the restraints were discontinued or if so, when they were discontinued.

A physician's order dated 12/8/2020 at 2:00 PM revealed an order for soft limb restraints for bilateral upper extremities due to Patient #2 persisting in efforts to disconnect medical equipment. There was no documentation Patient #2 was in restraints from 12/5/2020 at 7:00 AM to 12/8/2020 at 2:00 PM.

The "Restraint/Seclusion Flowsheet" dated 12/8/2020 revealed there were no alternative interventions attempted prior to initiation of the restraints documented.

A physician's order dated 12/10/2020 at 9:00 AM revealed an order for soft limb restraints for bilateral upper extremities due to Patient #2 persisting in efforts to disconnect medical equipment.

The "Restraint/Seclusion Flowsheet" dated 12/10/2020 revealed restraint monitoring was documented as performed until 12/10/2020 at 7:00 PM. There was no documentation the restraints were discontinued or if so, when they were discontinued. There was no documentation of restraint monitoring from 12/10/2020 at 7:00 PM to 12/11/2020 at 7:00 AM.

A physician's order dated 12/11/2020 at 9:00 AM revealed an order for soft limb restraints for bilateral upper extremities due to Patient #2 persisting in efforts to disconnect medical equipment.

The "Restraint/Seclusion Flowsheet" dated 12/11/2020 revealed restraint monitoring was documented as performed until 12/11/2020 at 7:00 PM. There was no documentation the restraints were discontinued or if so, when they were discontinued. There was no documentation of restraint monitoring from 12/11/2020 at 7:00 PM to 12/12/2020 at 7:00 AM.

A physician's order dated 12/15/2020 at 9:00 AM revealed an order for soft limb restraints for bilateral upper extremities due to Patient #2 persisting in efforts to disconnect medical equipment and moving extremities in a manner and setting that could result in injury.

The "Restraint/Seclusion Flowsheet" dated 12/15/2020 revealed restraint monitoring was documented as performed until 12/15/2020 at 7:00 PM. There was no documentation the restraints were discontinued or if so, when they were discontinued.

3. In an interview in the Quality Management Office on 1/25/2021 at 9:00 AM, the Clinical Informaticist stated the documentation for restraints was done on paper ("Restraint/Seclusion Flowsheet"). The Clinical Informaticist stated nurses document on patient safety measures, toileting, and least restrictive measures. The Clinical Informaticist stated the nurses should document restraint monitoring at least every two hours. The Clinical Informaticist confirmed the nurses should document if a restraint was discontinued.