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DETROIT RECEIVING HOSPITAL 4201 ST ANTOINE ST - 2C DETROIT, MI 48201 April 19, 2017
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0174
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on observation, interview, and document review the facility failed to document restraint use every 15 minutes as required in one of five patients (pt.#1) resulting in the potential of denying all patients requiring restraint use patient rights. Findings include:

On 4/17/2017 at 1130 during initial tour of the emergency department of the facility a patient (pt.#1) was observed in the Transitional Care Unit (TCU) in bay #2 talking in a loud voice. The patient was observed sitting up and was dressed in a yellow gown. Staff J was asked if the yellow gown designated anything to staff members. Staff J stated "yes, that yellow gown is designation for a patient with high observation status." The patient was observed in restraints. Staff J was then asked if the patient was in high observation status why the patient was not located closer to the nurses' station where she might be in close vicinity to be observed. Staff J was unable to answer the question. The patient was then moved across from the nurses' station.

On 4/17/2017 at 1150 documentation review occurred of the patient's (pt. #1) medical record. The patient was a [AGE] year-old female that currently resides in an adult foster care setting. According to the patient's history and physical the patient has suffered from mental illness and drug abuse for 30 plus years. The patient record contained an order for restraint use dated 4/17/2017 at 0825 by the physician. The patient, according to documentation, was in need of restraint use related to danger of physical harm to self, danger of physical harm to staff, and destruction of property. The restraint order was for two hard leather restraints. Staff J was asked if the patient (pt. #1) was to have two hard leather restraints and not one as observed. Staff J responded "yes. She does have two restraints. The other restraint is not visible because the blanket is covering her arm." Further review of the order states use of restraints on opposite extremities was verified. Further review of the document titled "Adult restraint flow record, behavioral health standard non-psychiatric care units" revealed documentation at 0825, 0840, 0855, 0900, 0915, 0930, and 1000. At 1140 no further documentation could be provided for restraint documentation.

On 4/17/2017 at 1140 staff J was queried as to the requirement for restraint use documentations. Staff J stated "restraints for hard leather restraint use is supposed to be every 15 minutes." Staff J was then asked if documentation could exist elsewhere for restraint use documentation. Staff J responded "no." Staff J was then asked if the patient was to have two restraints on per the physician's order. Staff J stated "yes."

On 4/17/2017 at 1400 a review of the policy titled "Restraint use in the non-psychiatric healthcare setting" dated 4/12/2016 occurred. According to the policy (pg. 13) under subtitle "violent / self destructive behavior" for nursing assessment and documentation required is "On-going throughout the episode of restraint: minimally continuous first 15 minutes then every 15 minutes as documented by RN or HCP (healthcare professional).