HospitalInspections.org

Based on review of documentation, it was determined that the Governing Body failed to enforce the hospital ' s own policies and procedures.

Findings were:

Facility policy entitled " Restraint for Behavior Management " stated " All staff who have direct patient contact must have ongoing education and training in the proper and safe use of seclusion and restraint application and techniques and alternative methods for handling behavior, symptoms, and situations that traditionally have been treated through the use of restraints or seclusion. "
The policy continued, " Orders for the use of seclusion or a restraint must never be written as a standing order or on an as needed basis (that is PRN). "

In the medical record of Patient # 1, Physician ' s Directions (Orders) written 9/12/08 at 0300 stated, " Nursing, per protocol, soft restraints, PRN.

Staff member # 3 had no evidence of Restraint and Seclusion and Crisis Intervention training in her employee file.

In an interview with the Director of Security and the Chief Nursing Officer, it was confirmed that an order was written for " PRN " restraints for Patient # 1. It was also acknowledged that Staff Member # 3 was lacking evidence of training in her employee file and that the hospital was not following its own policies in regard to these matters.

Based on review of documentation and interview, it was determined that the facility failed to ensure that the patient was free from all forms of abuse or harassment.

Findings were:

Facility policy entitled " Patient Rights and Responsibilities " stated that the patient has the right to " Considerate and respectful care as evidenced by: Consideration of the psychosocial, spiritual, and cultural differences that influence the understanding of illness. "

On 9/11/08, Patient # 1 was " hit in the facial area with a closed fist " by Staff Member # 3.

In an interview with the Director of Security on 5/12/10, it was confirmed that Patient # 1 was struck in the face by Staff Member # 3 during a physical restraint. It was acknowledged that this action was inappropriate and was not part of the hospital ' s training protocol.

Based on review of documentation, it was determined that the facility did not ensure that no " standing or PRN " orders would be written for restraint or seclusion.

Findings were:

Facility policy entitled " Restraint for Behavior Management " stated " Orders for the use of seclusion or a restraint must never be written as a standing order or on an as needed basis (that is PRN). "

The medical record of Patient # 1 had a Physician ' s order written on 9/12/08 at 0300 that stated, " Nursing, per protocol, soft restraints, PRN. "

In an interview with the Chief Nursing Officer on 5/12/10, the PRN restraint order was acknowledged. It was also confirmed that this order was not in keeping with facility policy.

Based on review of documentation, it was determined that the facility was unable to demonstrate competency of its staff in the application of restraints.

Findings were:

Facility policy entitled " Patient Care Policy " stated " All staff who have direct patient contact must have ongoing education and training in the proper and safe use of seclusion and restraint application and techniques and alternative methods for handling behavior, symptoms, and situations that traditionally have been treated through the use of restraints or seclusion. "

Staff member # 3 had no evidence of Restraint and Seclusion and Crisis Intervention training in her employee file.

In an interview with the Director of Security, it was acknowledged that Staff Member # 3 was lacking verification of training in Crisis Intervention and in Restraint and Seclusion.