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.

ALEXIAN BROTHERS MEDICAL CENTER 1 800 W BIESTERFIELD RD ELK GROVE VILLAGE, IL 60007 Sept. 21, 2017
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 that for 1 of 2 (Pt #10) clinical records reviewed of a patient requiring the use of a restraint device, the Hospital failed to ensure that restraints were applied in accordance with a written physician's order.

Findings include:

1. The Hospital policy entitled, "Use of Restraint and Seclusion," (revision dated 5/31/16) was reviewed on 9/21/17 and required, "...V. Procedures...D. Non-Violent, Non-Self-Destructive Restraint. a. Use of a restraint or seclusion requires a physician's order..."

2. The clinical record of Pt #10 was reviewed on 9/21/17 at approximately 8:45 AM. Pt #10 was a [AGE] year old female admitted on [DATE] with a diagnosis of cellulitis lower extremity. Clinical documentation included that on 9/18/17 at 4:00 PM Pt #10 had a vest restraint applied. The clinical record did not include documentation of a physician's order for the application of the restraint device.

3. On 9/21/17, at approximately 10:10 AM, the Assistant Director (E#8) of the Telemetry Unit stated that a physician's order could not be located for the the patient's restraints.