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.

SHERMAN HOSPITAL 1425 NORTH RANDALL ROAD ELGIN, IL 60123 Jan. 22, 2016
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0168
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on document review and interview, it was determined for 1 of 5 (Pt. #6) clinical records reviewed for restraint usage, the Hospital failed to ensure an order for restraints was written as required.

Findings include:

1. The Hospital policy titled, "Utilization of Restraint and Seclusion (reviewed on 5/5/15)" was reviewed on 1/21/16. The policy required, "Use of restraint and seclusion is based upon the order of a physician."

2. The clinical record of Pt. #6 was reviewed on 1/21/16. Pt. #6 was a [AGE] year old male who (MDS) dated [DATE] with an eye contusion after an altercation. Pt. #6 was placed in leather restraints on 11/29/15 at 3:30 AM. The restraints were removed on 11/29/15 at 10:00 AM. Pt. #6 was discharged from the ED on 11/29/15 at 10:50 AM. The order for restraints was written on 12/1/15 at 6:48 AM (after discharge).

3. During an interview on 1/21/16 at 11:00 AM, the Clinical Informatics Coordinator stated, that was the only order available in the computer system.
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0175
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on document review and interview, it was determined for 1 of 5 (Pt. #5), clinical records reviewed for restraint usage, the Hospital failed to ensure the patient was monitored as per policy.

Findings include:

1. The Hospital policy titled, "Utilization of Restraint and Seclusion (reviewed on 5/5/15)" was reviewed on 1/21/16. The policy required, "RN assessment of the patient will occur no less often than every 2 hours..."

2. The clinical record of Pt. #5 was reviewed on 1/21/16. Pt. #4 was an [AGE] year old female admitted on [DATE] with the diagnosis of fractured hip. An order for restraints was written on 10/11/15 at 1:33 AM due to cognitive impairment interfering with care. Pt. #5 remained in restraints until 10/13/15 at 3:00 PM. The clinical record lacked documentation of every 2 hour restraint monitoring for the following times: 10/12/15 - 2:00 AM, 12:00 PM, 2:00 PM and 8:00 PM.

3. During an interview on 1/21/16 at 11:00 AM, the Clinical Informatics Coordinator stated the restraint monitoring was not documented as per policy.