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.

ST VINCENT HOSPITAL 123 SUMMER STREET WORCESTER, MA 01608 Sept. 27, 2017
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0196
Based on record review and interview for one of eleven sampled patients (Patient #8), the Hospital failed to train its unlicensed staff who monitored patients in restraints, in restraint use or to require a demonstration of their competency.

Findings include:

Patient #8's Restraint Flow Sheet, dated 8/29/17, indicated that Patient Observer #1 monitored Patient #8 while in 4-point physical restraints from approximately 5:30 P.M. to 8:45 P.M.

Patient Observer #1's education and training file indicated there was no restraint training, or demonstrated competency, including patient monitoring.

The Surveyor interviewed Nurse Educator #1 at 1:30 P.M. on 9/27/17. Nurse Educator #1 said that the job description for Patient Observers, including Constant Observers and Sitters, did not include restraint training because they did not have physical contact with the restrained patients they observed.

The Constant Observer job description, dated January 2017, indicated the Constant Observer ensures patients safety and prevents patients from inflicting harm to selves and others. The Policy indicated the Constant Observer keeps patients under constant observation, provides escorts, provides diversional activities, and performs duties to maintain personal and patients safety (utilizes principles of body mechanics and personal safety skills). The job description did not reference a requirement for restraint training or competency.

The Restraint and Seclusion Policy, dated 5/5/14, indicated that monitoring of the restrained patient is accomplished by observation and direct face-to face interaction with the patient by trained and competent staff. The Policy indicated that all staff who are involved in monitoring the condition of the restrained patient must have ongoing education training in the proper and safe use of restraints. The Policy indicated that the employee must have documented competency in safely applying, monitoring and removing restraints before the employee participates in any use of restraint.
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0202
Based on record review and interview, for one of eleven sampled patients (Patient #8), the Hospital failed to train its unlicensed staff who monitored restrained patients in how to respond to signs of physical and physiological distress.

Findings include:

Patient #8's Restraint Flow Sheet, dated 8/29/17, indicated that Patient Observer #1 monitored Patient #8 while in 4-point physical restraints, from approximately 5:30 P.M. to 8:45 P.M.

Patient Observer #1's education and training file indicated there was no restraint, cardiopulmonary resuscitation (CPR), or first aid training documentation.

The Surveyor interviewed Nurse Educator #1 at 1:30 P.M. on 9/27/17. Nurse Educator #1 said that the job description for the Patient Observers, including Constant Observers, did not require restraint, CPR or first aid training. Nurse Educator #1 said it was the responsibility of the Patient Observer or Sitter to alert nursing staff if a patient was in physical or physiological distress. Nurse Educator #1 said that the Hospital had not provided specific training to Patient Observers and Sitters that identified signs of patient distress while in restraints.

The Constant Observer job description, dated January 2017, indicated the Constant Observer ensures patient safety and prevents patients from inflicting harm to self and others. The Policy indicated the Constant Observer keeps patients under constant observation, provides escorts, provides diversional activities, and performs duties to maintain personal and patient safety (utilizes principles of body mechanics and personal safety skills). The job description did not reference a requirement for how to respond to signs of patient physical and physiological distress while in restraints, restraint training, CPR or first aid techniques.

The Restraint and Seclusion Policy, dated 5/5/14, indicated that monitoring of the restrained patient is accomplished by observation, and direct face-to face interaction with the patient by trained and competent staff. The Policy indicated that all staff who provide care for a patient in restraint must have ongoing education training in the proper and safe use of restraints.
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0206
Based on record review and interview, for one of eleven sampled patients (Patient #8), the Hospital failed to ensure that its unlicensed staff, who were assigned to monitor patients in restraints, were certified in cardiopulmonary resuscitation (CPR) and trained in first aid.

Findings include:

Patient #8's Restraint Flow Sheet, dated 8/29/17, indicated that Patient Observer #1 monitored Patient #8 while in 4-point physical restraints, from approximately 5:30 P.M. to 8:45 P.M.

Patient Observer #1's education and training file indicated there was no CPR, or first aid training documentation.

The Surveyor interviewed Nurse Educator #1 at 1:30 P.M. on 9/27/17. Nurse Educator #1 said that the job description for the Patient Observers, including Constant Observers, did not require either CPR or first aid training. Nurse Educator #1 said the Hospital did not provide first aid training either as a general class, or specifically as it pertained to restrained patients.

The Constant Observer job description, dated January 2017, indicated the Constant Observer ensures patient safety and prevents patients from inflicting harm to self and others. The Policy indicated the Constant Observer keeps patients under constant observation, provides escorts, provides diversional activities, and performs duties to maintain personal and patient safety (utilizes principles of body mechanics and personal safety skills). The job description did not reference a requirement for CPR or first aid training.

The Restraint and Seclusion Policy, dated 5/5/14, indicated that monitoring of the restrained patient is accomplished by observation, direct face-to face interaction with the patient by trained and competent staff. The Policy indicated that this education and training must include the use of first aid techniques and certification in the use of cardiopulmonary resuscitation.