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Based on clinical record review, review of policies and procedures and interview it was determined the Facility failed to follow their policy to attempt less restrictive alternatives (i.e. calming music, quiet environment) prior to administering chemical restraints in two (#2 and #8) of two clinical records for patients receiving chemical restraint. Failure to attempt less restrictive alternatives prior to administering chemical restraints prevented patients from being allowed to de-escalate and avoid the use of restraint. The failed practice was likely to affect all 10 patients on current census in the Geropsychiatriac Unit. Findings follow:

A. Review of Policy, "Restraint and Seclusion" revealed restraints/seclusion are only used when clinical justified after attempting appropriate less restrictive alternatives; restraints/seclusion will be used solely for the purpose of protecting the patient from injury to him/herself or others; and 5. Chemical Restraint: a medication used to control behavior or to restrict the patient's freedom of movement and is not a standard treatment for the patient's medical or psychiatric diagnosis. Documentation of purpose for restraint, less restrictive alternatives attempted prior to restraint ...clinical justification, and a description of the patient ... is to be documented.

B. Review of Nursing Notes dated 08/18/15 at 1353 for Patient #8 revealed Patient agitated, Yelling, cursing, combative. Haldol 7.5 mg (milligram) and Cogentin 2 mg administered IM (intramuscular). There was no evidence nursing staff attempted less restrictive alternatives in an attempt to calm Patient #8 prior to administering chemical restraint.

C. Review of Patient Chart Report (Medication Administration Report) dated 08/18/15 at 1352 for Patient #8 revealed 7.5 mg Haldol was administered IM as a one time dose.

D. Review of Nursing Notes dated 08/19/15 at 1048 for Patient #8 revealed Patient is combative with care, hitting and pinching staff, yelling and cursing. Orders received for IM Haldol and Cogentin. There was no evidence nursing staff attempted less restrictive alternatives in an attempt to calm Patient #8 prior to administering chemical restraint.

E. Review of Patient Chart Report (Medication Administration Report) dated 08/19/15 at 1037 for Patient #8 revealed Haldol Inj (injection) 10 mg/ml (milligram/milliliter) solution was administered intramuscularly as a one time dose.

F. Review of Nursing Notes dated 08/28/15 at 2047 for Patient #2 revealed Patient #2 became angry, agitated and threatening. She stated did we know she was an Indian and would kill us all. She threw her blanket on the floor and tried to throw a walker. Patient was given Ativan 0.5 mg. po (by mouth) for agitation. There was no evidence nursing staff attempted less restrictive alternatives in an attempt to calm Patient #2 prior to administering chemical restraint.

G. Review of Patient Chart Report (Medication Administration Report) dated 08/28/15 at 2052 for Patient #2 revealed Ativan 0.5 mg was administered.

H. Findings listed as B-G were confirmed with the Program Director during record review 09/01/15 at 1330.

Based on review of clinical records and interview, it was determined the Facility failed to assure care plans included treatment strategies/interventions for agitation and/or aggression in two (#2 and #8) of two clinical records for patients receiving chemical restraint. Failure to include strategies/interventions for patients exhibiting agitation and/or aggression prevented staff from assuring least restrictive means of calming patients' behavior prior to administering chemical restraint was attempted. The failed practice was likely to affect all 10 patients on current census in the Geropsychiatriac Unit. Findings follow:

A. Review of the Individual Interdisciplinary Treatment Plan for Patients #2 and #8 revealed no evidence treatment strategies/interventions for agitation and/or aggression was included.

B. Findings were confirmed with the Director of Nursing on 09/01/15 at 1330 at the time of record review.