The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

BAXTER REGIONAL MEDICAL CENTER 624 HOSPITAL DRIVE MOUNTAIN HOME, AR 72653 May 31, 2017
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0166
Based on clinical record review and interview, it was determined the Facility failed to update the plan of care for five of five (#2, #3, #8, #12, #13) patients reviewed who were placed in restraints. Failure to include the use of restraints in the plan of care did not reflect a process of assessment, intervention and evaluation by the Interdisciplinary Team when restraints were used and was likely to affect all patients who were restrained. Findings follow:

A. Review of Patient #2's clinical record revealed the Patient was in restraints from 03/11/17 at 0400 to 03/12/17 at 1600. There was no evidence the Patient's plan of care was updated to reflect the use of restraints. Findings were confirmed by the Intensive Care Unit (ICU) Charge Nurse on 05/31/17 at 1321.

B. Review of Patient #3's clinical record revealed the Patient was in restraints from 05/24/17 at 1000 to 05/25/17 at 0800 and from 05/28/17 at 0700 to 05/30/17 at 1100. There was no evidence the Patient's plan of care was updated to reflect the use of restraints. Findings were confirmed by the ICU Charge Nurse on 05/31/17 at 1314.

C. Review of Patient #8's clinical record revealed the Patient was in restraints from 05/28/17 at 0500 to 05/29/17 at 0800. There was no evidence the Patient's plan of care was updated to reflect the use of restraints. Findings were confirmed by the ICU Charge Nurse on 05/31/17 at 1430.

D. Review of Patient #12's clinical record revealed the Patient was in restraints from 03/09/17 at 1900 to 03/12/17 at 0115. There was no evidence the Patient's plan of care was updated to reflect the use of restraints. Findings were confirmed by the ICU Charge Nurse on 05/31/17 at 1452.

E. Review of Patient #13's clinical record revealed the Patient was in restraints from 03/11/17 at 1200 to 03/14/17 at 0900. There was no evidence the Patient's plan of care was updated to reflect the use of restraints. Findings were confirmed by the ICU Charge Nurse on 05/31/17 at 1508.
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0168
Based on clinical record review, Policy and Procedure review and interview, it was determined three (#3, #12, #13) of five (#2, #3, #8, #12, #13) Patients were not restrained in accordance with a Physician's order. Failure to obtain a physician's order for restraints did not allow the Physician to be knowledgeable regarding the patient's need for restraints. The failed practice affected Patient #3, #12 and #13 and was likely to affect all patients who were restrained. Findings follow:

A. Review of the policy and procedure for Limb Restraint Application on 05/30/17 at 1425 revealed "1. Physician Order Requirements: Non-violent/Non-Self Destructive patients. Every 24 hours: Physician must evaluate patient for ongoing need for restraints. Every 24 hours: Physician must write order to renew restraints." Implementation: "Obtain a practitioner's order for the restraints."

B. Review of Patient #3's clinical record revealed the Patient was in restraints from 05/24/17 at 1000 to 05/25/17 at 0800 and 05/28/17 at 0700 to 05/30/17 at 1100. During onsite clinical record review on 05/31/17, the Facility could not provide any evidence of a Physician's order for restraints for the dates of 05/24/17 or 05/28/17. Findings were confirmed by the ICU Charge Nurse on 05/31/17 at 1314.

C. Review of Patient #12's clinical record revealed the Patient was in restraints from 03/09/17 at 1900 to 03/12/17 at 0115. During onsite clinical record review on 05/31/17, the Facility could not provide any evidence of a Physician's order for dates of 03/09/17-03/12/17. Findings were confirmed by the ICU Charge Nurse on 05/31/17 at 1452.

D. Review of Patient's #13's clinical record revealed the Patient was in restraints from 03/11/17 at 1200 to 03/14/17 at 0900. During onsite clinical record review on 05/31/17, the Facility could not provide any evidence of a Physician's order for restraints for the dates of 03/11/17-03/14/17. Findings were confirmed by the ICU Charge Nurse on 05/31/17 at 1508.