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.

LAUREL REGIONAL MEDICAL CENTER 7300 VAN DUSEN ROAD LAUREL, MD 20707 Jan. 12, 2017
VIOLATION: PROGRAM SCOPE, PROGRAM DATA Tag No: A0273
Based on a review of restraints and seclusions, it was determined that the hospital has no current data on restraint/seclusion events.

A review of restraint/seclusion events prompted a request for current quality data. The hospital was not able to produce any current data. Further review found that there had recently been a change in staffing which may have contributed, but that other quality concerns such as training of staff was up-to-date. However, no data had been gathered regarding the actual restraint/seclusion events for improvement purposes which does not meet regualatory requirements of quality assurance and performance improvement of patient care activities.
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0174
Based on a review of patient #7's record, it is revealed that 1) every fifteen-minute behavioral documentation for a restraint were not completed; 2) ongoing justification for a seclusion did not meet requirements; and 3) documentation of behaviors revealed calm behaviors though patient #7, all of which did not allow a determination that patient #7 was released at the earliest possible time.

Patient #7 was an adult female who admitted to the behavioral health unit in September 2016. Patient #7 was appropriately restrained in two-point violent restraint from 2345 until 0055 due to harming staff.

The Behavioral Observation flow Sheet revealed spaces to document every fifteen-minute behaviors. For patient #7, no fifteen-minute documentation of behaviors was found. While the restraint was limited to 55 minutes once patient #7 fell asleep, a lack of behavioral documentation made it impossible to determine if patient #7 was released at the earliest possible time.

Patient #7 was subsequently secluded from 0530 to 0700 after she began throwing things at staff. Nursing justification for the seclusion documented on the Behavioral Observation Flow Sheet revealed the statement, "Unable to follow directions." While patient #7 was showing behaviors which were a danger to others, being unable to follow directions was not of itself a criterion to seclude.

From 0600 through 0700, patient #7 was documented as laying on the mattress, quiet but knocking on the glass, and patient appears to be resting. Based on these behaviors, patient #7 no longer demonstrated behaviors which were a danger to others or herself

Based on all documentation, patient #7 was appropriately placed into restraint and seclusion. However, ongoing documentation failed to demonstrate that patient #7 was released at the earliest possible time.