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.

ADVOCATE LUTHERAN GENERAL HOSPITAL 1775 DEMPSTER ST PARK RIDGE, IL 60068 Jan. 3, 2017
VIOLATION: PATIENT RIGHTS: NOTICE OF RIGHTS Tag No: A0117
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on document review and interview, it was determined for 1 of 3 (Pt. #6) records reviewed with restraint usage the Hospital failed to ensure patients were provided with the restriction of rights notification.

Findings include:

1. The Hospital policy titled, "Utilization of Restraints and Seclusion" (rev. 6/27/16), was reviewed on 1/3/17 at approximately 2:30 PM. The policy required, "D: Restraints and Seclusion for Violent or self Destructive Behavior....3.a.(1) As early as possible in the restraint and seclusion process, the patient will be made aware of the rationale for restraint use.... Patient's...will be provided with a copy of the Mental Health Restriction of Rights form...A copy of the form will be placed in the medical record.

2. The Clincial record for Pt. #6 was reviewed on 1/3/17 at approximately 1:00 PM. Pt. #6 was a [AGE] year old female, admitted on [DATE], with a diagnosis of polysubstance abuse. The clinical record contained 3 separate Restraints orders: on 12/21/16 at 4:23 PM with a renewal at 8:00 and 11:00 PM; on 12/22/16 at 3:31 AM; and on 1/1/17 at 12:56 PM. The record lacked the "Notice of Restriction of Rights" for the restraint usage.

3. The above findings were discussed with the Director of Clinical Excellence, during an interview on 1/3/16 at approximately 3:00 PM, who stated that the Notice of Restriction of Rights could not be found in the patient's record and is required by policy. The Director stated there should have been 3 Notice of Restriction of Rights in the patient record.