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INOVA MOUNT VERNON HOSPITAL
PATIENT RIGHTS: RESTRAINT OR SECLUSION
Tag No.: A0168
Based on staff interview and document review, it was determined the facility staff failed to apply restraints in accordance with the physician's order in one (1) of three (3) applicable records reviewed in the survey sample. Medical record #9.
Findings:
Nine (9) medical records were reviewed 05/08/23 with the assistance of the Regulatory Affairs Consultant. Three (3) of the nine (9) records reviewed contained orders for patient restraints. The medical record for #9 indicated the patient presented to the emergency department (ED) on 03/05/23 with alcohol intoxication. The physician ordered bilateral soft wrist restraints at 5:12 AM on 03/05/23. The Registered Nurse (RN) documented at 5:25 AM that the following restraints were "started:" four side rails up, soft limb restraints to right wrist, soft wrist restraints for left wrist, soft limb restraints to right ankle, soft limb restraints to left ankle. The RN documented that the wrist and ankle restraints were discontinued at 06:15 AM on 03/05/23. There was no documentation in the medical record that the four side rails were ever discontinued and no further restraint monitoring was documented. The medical record failed to contain evidence of a provider order for right ankle restraint, left ankle restraint, or the use of all four side rails.
An interview was conducted with the ED Director (staff member #4) on 05/08/23 at 3:15 PM. Staff member #4 stated that the ED does not have beds with four side rails and stretchers are used. Additionally, staff member #4 stated that the ED does not have soft ankle restraints and believed the restraints were documented in error by a travel nurse no longer working at the facility.
The facility's policy, IHS Restraints and Restraint Alternatives Policy was reviewed and reads in part: "Use requires an active order by a physician or credentialed APP."
The above noted deficiency was reviewed with the Regulatory Affairs Consultant, Chief Nursing Officer, and other leadership staff during the exit conference on 05/08/23.