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.

HENRY FORD HOSPITAL 2799 W GRAND BLVD DETROIT, MI 48202 Dec. 27, 2012
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0168
Based on interview, policy and record review, the facility failed to ensure that 1 of 1 Emergency Department patients (patient #2) was physically restrained according to facility policies. Findings include:

1. From 12/26/12-12/27/12 review of patient #2's clinical record revealed that on 8/22/12 at 8:19 pm, the patient was physically restrained when attempting to leave the Emergency Department during a mental status assessment. Patient #2 was reported to be: "..... shouting at staff" and "...... tried to push a Tech."
2. Patient #2's clinical record for 8/22/12 revealed physician orders at 8:24 pm for, "4 point hard restraints" and at 8:25 pm for restraint application category, "Non-violent Non-Self-destructive-every 2-hour check" the rationale for which included, ".... risk of harm to others, risk of harm to self."
3. On 8/23/12 at 2:23 am the Emergency Department Charge Nurse documented that the patient was released from restraints.
4. The patient's record did not contain a one-hour physician evaluation as required by facility policy, "Restraint and Seclusion, EHR010" which states that when restraints are applied for violent or self-destructive behavior restraints must be ordered/re-ordered for: "A maximum of every 4 hours for adults 18 years and older."
5. On 12/27/12 at approximately 3:30 pm the Emergency Department (ED) Administrator stated that patient #'2's episode of restraint on 8/22/12 should have been ordered for violent, not "non-violent" behavior, and been subject to the order/re-order requirements noted in hospital policy EHR010. The ED Administrator also verified that the patient's record did not contain evidence of physical restraints being reordered by a physician within 4 hours of application, although restraint continued.
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0179
Based on interview, policy and record review, the facility to ensure that 1 of 1 Emergency Department patients (#2) was provided with a physician/physician assistant assessment within 1 hour of restraint application, per policies. Findings include:

1. From 12/26/12-12/27/12 review of patient #2's clinical record revealed that on 8/22/12 at 8:19 pm the patient was physically restrained when attempting to leave the Emergency Department during a mental status assessment. It was noted that the patient was "shouting at staff" and "tried to push a Tech."
2. The patient's record for 8/22/12 revealed physician orders at 8:24 pm for "4 point hard restraints" and at 8:25 pm for "restraint application category "Non-violent Non-Self-destructive-every 2-hour check" for "risk of harm to others, risk of harm to self."
3. On 8/23/12 at 2:23 am the Emergency Department Charge Nurse documented that the patient was released from restraints.
4. The patient's record did not contain a one-hour physician evaluation as required by facility policy "Restraint and Seclusion," EHR010, which states that when restraints are applied for violent or self-destructive behavior: "Physicians/PA's (Physician Assistants) must perform a face-to-face assessment of the initiation of restraint/seclusion."
5. On 12/27/12 at approximately 3:30 pm the Emergency Department Administrator stated that patient #'2's episode of restraint on 8/22/12 should have been ordered for violent, not non-violent behavior and was subject to the 1-hour face-to-face assessment requirement noted in hospital policy EHR010. The ED Administrator verified that the clinical record did not contain evidence of a 1-hour face-to-face assessment being completed.