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.

NORTH METRO MEDICAL CENTER 1400 BRADEN STREET JACKSONVILLE, AR 72076 July 13, 2016
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0175
Based on clinical record review, policy review and interview, it was determined the Facility failed to ensure four of four (#3 and #5-#7) patients in restraints were reassessed every two hours per policy. The failed practice did not ensure restrained patients' needs were addressed at timely intervals; did not ensure patients were released from restraints at the earliest possible time; and did not ensure the least restrictive restraint was being used. The failed practice had the potential to affect any patient in restraints. Findings follow.

A. Review of policy titled "Restraint/Seclusion" stated, "Reassess and assist the patient at least every two hours to determine: i) Signs of any injury associated with the application of restraints; j) Whether patient meets criteria for release of restraint; k)Nutrition and hydration; l) Circulation and range of motion in the extremities and appropriate application; m) Hygiene and elimination; n) Physical and psychological status and comfort; o) That rights, dignity and safety of the patient are maintained; p) Whether less restrictive methods of restraint are possible."
B. Review of clinical records revealed the following:
1). Patient #3 had orders for restraints from 04/18/16 at 0006 through 04/24/16 at 1200. Patient #3 was not reassessed every two hours on 04/18/16 from 0006 through 0800, 04/20/16 from 0600 through 1000, on 04/22/16 from 1600 through 2000, on 04/23/16 from 0000 through 0400 and from 0400 through 1800 and on 04/24/16 from 0200 through 0800.
2) Patient #5 had orders for restraints from 06/25/16 at 0130 through 06/30/16 at 0830. Patient #5 was not reassessed every two hours on 06/26/16 from 0400 through 0800 and on 06/27/16 from 1400 through 1800.
3) Patient #6 had restraint orders on 06/01/16, 06/03/16 through 06/06/16, 06/15/16 through 06/17/16, 06/19/16 through 06/21/16, and 06/28/16 through 06/30/16. Patient #6 was not reassessed every two hours on 06/03/16 at 2000 through 06/04/16 at 0000, on 06/05/16 at 1200 through 1600, on 06/15/16 at 2200 through 06/16/16 at 0200, on 06/16/16 at 1000 through 2000, on 06/17/16 at 0800 through 1205 and 1205 through 2000, on 06/19/16 at 0800 through 1200 and 1200 through 2000, on 06/20/16 at 0800 through 06/21/16 (no time on the order for 06/21), on 06/28/16 at 1300 through 1700 and 1700 through 2000, and on 06/29/16 at 1800 through 06/30/16 at 0000.
4) Patient #7 had restraint orders for 07/10/16 at 1835 through 07/13/16 at 0700. Patient #7 was not reassessed every two hours on 07/11/16 from 0600 through 2000 and on 07/12/16 at 0600 through the time of record review on 07/13/16 at 1100.
C. During an interview on 07/13/16 at 0914 and 1043, the Quality Director confirmed the lack of reassessments for Patient #3, #5, and #6. During an interview on 07/13/16 at 1143, the Director of Inpatient Services confirmed the lack of reassessments for Patient #7.
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0168
Based on clinical record review, policy review and interview, it was determined the Facility failed to ensure patients were not restrained without a physician's order (#6) and failed to ensure physician's verbal orders were timed and dated when they were signed for four of four (#3 and #5-#7) Patients with restraints. Restraining patients without a physician's order did not ensure the restraint was necessary and was the least restrictive intervention. Failure to ensure restraint orders were dated and timed did not ensure orders were signed within the 24 hour window as specified per policy. Findings follow.

A. Review of policy titled, "Restraint/Seclusion" revealed, "Verbal orders for restraints must be co-signed within 24 hours. The physician must assess the patient at that time. Orders must be renewed at least every 24 hours. The physician must personally observe, evaluate and document the continued need for physical restraint every 24 hours."
B. Review of clinical records revealed the following:
1) Patient #3 - 7 of 7 verbal orders for restraints were not dated and timed when they were signed by the Physician.
2) Patient #5 - 5 of 5 verbal orders for restraints were not signed, dated or timed by the Physician.
3) Patient #6 - 15 of 15 verbal orders for restraints were not dated and timed when they were signed by the Physician. There was evidence of restraint monitoring on eleven days with no order for restraints (06/02/16, 06/07/16, 06/15/16, 06/18/16, 06/23/16, 06/24/16, 06/26/16, 06/27/16, 07/01/16, 07/02/16, and 07/03/16).
4) Patient #7 - 4 of 4 verbal orders for restraints were not dated and timed when they were signed by the Physician.
C. During an interview on 07/13/16 at 1043, the Quality Director confirmed the orders were not dated and timed and confirmed the restraint monitoring without restraint orders.
VIOLATION: PATIENT RIGHTS: SECLUSION OR RESTRAINT Tag No: A0214
Based on observation, Death While In Restraints Log review, policy review and interview, it was determined the Facility failed to ensure one of one (#6) Patient that died within 24 hours of being in restraints was documented on the Death While In Restraints Log. The failed practice did not ensure the Facility was tracking and trending patients who died after recent restraint use and created the potential to affect any patient in restraints. Findings follow.

A. Review of the clinical record of Patient #6 revealed the patient was last in restraints (bilateral wrist restraints) at 0400 on 07/03/16.
B. Review of the Record of Death for Patient #6 revealed a time of death of 0850 on 07/03/16.
C. Review of the Death While In Restraints Log, received from the Quality Director on 07/12/16, revealed the Facility had had no deaths in restraints for January 2016 through December 2016.
D. Review of policy titled "Restraint/Seclusion" stated, "Death Reporting Requirements: In accordance with CMS, North Metro Medical Center will use the following protocol in reporting death(s) associated with the use of seclusion AND restraints: ...Each death that occurs within 24 hours after the patient has been removed from restraint or seclusion ...When no seclusion has been used and when the only restraints used on the patient are those applied exclusively to the patient's wrist(s) ...the hospital staff must record in an internal log the same information that is reported to CMS when seclusion and restraints have been used."
E. During an interview on 07/13/16 at 1043, the Quality Director confirmed Patient #6 was not listed on the Death While In Restraints Log.