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.

NORTHWEST HOSPITAL CENTER 5401 OLD COURT ROAD RANDALLSTOWN, MD 21133 June 7, 2017
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0171
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on review of the medical record, staff interviews and hospital policy during an onsite investigation completed on June 6, 2017, it was determined that the facility failed to maintain the required time limits for use of violent /self-destructive restraints on an adolescent.

The patient, an adolescent between the ages of 9-[AGE] years old, was in restraints on four occasions. The second order for restraints was written one hour after the first order expired even though the patient remained in restraints. There was no documentation of when the restraints were discontinued. For the third order for restraints, the patient remained in restraints for two hours and 15 minutes longer than the maximum allowable time of two hours. Auto stop parameters of four hours were included in the orders for the third and fourth restraint episodes, but exceed the hour time limit for adolescents. The medical record lacked documentation of the time the restraints were removed from this adolescent for the last two episodes.
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0179
Based on review of the medical record, staff interviews and hospital policy during an onsite investigation completed on June 6, 2017, it was determined that the facility failed to complete 1-hour face- to- face evaluations with every new restraint order. It was determined that the hospital failed to perform a complete face to face evaluation of one adolescent emergency department patient for three of four restraint episodes.

The patient was placed in "Twice as Tough"(TAT) four point restraints for violent behavior on four occasions while in the emergency department. Documentation regarding the first episode of restraint consisted of a nurse's note and verbal order. No 1 hour face-to-face physician exam was found. The face-to-face for the second and third episode was also incomplete containing lacking all four required elements.
VIOLATION: PATIENT RIGHTS: INFORMED CONSENT Tag No: A0131
Based on record review of 8 open medical records and 8 closed medical records on June 6, 2017 it was determined that a patient who was alert and oriented did not sign some of their own consents. Patient #15 presented to the emergency department for bilateral back pain, decreased appetite and general weakness. The patient had a general consent to treat and Important Message from Medicare form signed by a family member, who was not a Power of Attorney rather than him/herself. There was no indication in the medical record that the patient lacked capacity, could not sign their own forms or not be involved in making informed decisions regarding their care.