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.
|BELLEVUE MEDICAL CENTER||2500 BELLEVUE MEDICAL CENTER DR BELLEVUE, NE 68123||Aug. 16, 2012|
|VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION||Tag No: A0168|
|Based on record review, staff interview and review of facility restraint policy the facility failed to ensure 1 of 1 sampled patients (Patient 4) utilizing physical behavioral restraints had a renewal for continued restraint use after the previous order expired. The total sample size was 11. Findings are:
A. Record review of Emergency Department (ED) patient record for Patient 4 revealed the patient came to the ED with police on 6/3/12 at 3:18 AM. Admitting assessment data notes the patient had depression, bizarre behavior with suicidal and homicidal thoughts while in jail after a Driving while Under the Influence arrest. The patient was under the influence of alcohol with a blood alcohol level of 202 recorded at admission. Police handcuffs were on the patient on arrival and removed with the placement of hospital vinyl Velcro behavioral locking restraints to all 4 extremities placed at 3:45 AM. Review of ED physician orders reveals the original order for the behavioral physical restraint for 4 hrs dated 6/3/12 at 3:45 AM. At 7:45 AM (4 hours later) the order was renewed by the physician for another 4 hours. Nursing assessments identified the patient was still unable to contract for safety of others. The second restraint order at 7:45 AM expired at 11:45 AM. A renewal order was not written by the physician or a verbal order obtained by nursing. Restraint documentation demonstrates the patient continued to have 1 extremity restrained in a hospital applied restraint until transfer at 1:35 PM on 6/3/12 to a Mental Health facility. This finding was confirmed by interview with the ED Registered Nurse Manager on 8/10/12 at 12:40 PM.
B. Record review of facility policy titled "Restraints" effective date of 5/17/10 notes under Section E that "Physician Order for Adult patients restrained because of violent or self destructive behavior 1. Initial orders for adult patients restrained because of violent behavior will be: maximum of four hours." Under Part 2 the policy states "Re-evaluation of the continuation of the behavioral restraint order must be done in person as a 'face to face' assessment and written by the treating physician or as a verbal order by the registered nurse using the same parameters."