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.

AULTMAN HOSPITAL 2600 SIXTH STREET SW CANTON, OH 44710 April 13, 2017
VIOLATION: PATIENT RIGHTS Tag No: A0115
Based on medical record reviews, staff interviews, policy review, manufacturer's instructions and review of Security Services documentation, the facility failed to ensure all patients had the right to be free from physical or mental abuse and the right to be free from restraint/force or seclusion (A154) failed to ensure the medical record contained an order for restraints (161) failed to ensure the use of hand mitts was in accordance with a facility policy (167) failed to ensure the use of restraint was in accordance with the order of a physician or other licensed independent practitioner (168) failed to monitor restrained patients (175) failed to ensure a description of the patient's behavior and the intervention used were documented in the medical record and were sufficient to support the intervention (s) used (185) the facility failed to ensure alternatives or other less restrictive interventions attempted were documented in the medical record (186). The cumulative effect of this systemic practice resulted in a risk to the health and safety of all current and future patients.
VIOLATION: USE OF RESTRAINT OR SECLUSION Tag No: A0154
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on medical record reviews, staff interviews, policy review, manufacturer's instruction and review of Security Services documentation, the facility failed to ensure all patients had the right to be free from physical or mental abuse and the right to be free from restraint or force. This affected three of 26 patients whose medical records were reviewed for the use of restraint and/or force. (Patients' #1, #7 and #6 ) The census at the time of the survey was 310.

Findings include:

1. Review of the facility's "Investigation Report" dated 02/24/17 at 2:32 AM revealed security responded to an "incident" in the emergency room involving Patient #1. This patient was admitted on [DATE] at 1:56 PM from an extended care facility (ECF) for combative and behavior psychosis.

According to this report on 02/24/17 at 2:30 AM Officer D was on a standby in room R-3. Physician C entered Patient #1's room to "address what was going on with her and the required test he will need done." Patient #1 stated she would not comply with any test or treatment. Physician C then advised her that "refusal was not an option." Patient #1 "began to argue with the doctor and he stated he was not going to change his mind and the test will be performed with or without her consent. He informed her that she would be restrained if she would not comply." Physician C then "turned to" Officer D and told Officer D "to have her restrained." Officer D proceeded to radio for additional help from security. Officer E, Officer F, Officer G and Officer H responded.

Further review of the report revealed Patient #1 "was very combative and it was necessary for the officers to apply pressure point and joint lock techniques to place the patient in four points. The nursing staff then ran the tests that were necessary." The Officers were then "cleared" at 3:00 AM without further incident.

Review of the facility's policy "Police Aide/Use of Force/Escorts" was reviewed. Per policy, "the use of force should be avoided if at all possible. If the use of force becomes necessary, always remember the term reasonable force. The definition of reasonable force is only the force necessary to subdue the person." The policy provided no additional direction on the use of force.

Review of the facility's policy "Patient's Rights and Responsibilities" was reviewed which stated Patients also had the right to "understand the nature and purpose of any technical procedures ... and to refuse care." The policy also specified "patients have a right to remain free from unnecessary seclusion and restraints."

Patient #1's medical record was reviewed. Review of the medical record revealed the following documentation:

a. The History and Physical for Patient #1 was completed on 02/23/17 at 2:08 PM. The physician noted Patient #1 was alert and oriented times three, with appropriate mood and affect, and answering questions appropriately.

b. At 3:15 PM on 02/23/17 the Registered Nurse (RN) completed the Emergency Department (ED) Assessment Note and documented under chief complaint: "patient sent from ECF for combative behavior psychosis. Refuses any vital signs or treatment."

c. At 6:39 PM the Social Worker met with Patient #1 and documented she was "calm, speech is clear" patient "states she does not need medication that is why she is refusing it."

d. On 02/24/17 at 2:27 AM the RN documented she communicated to the physician that Patient #1 did not want blood work done. Patient #1 would like to talk to a supervisor, have some food and be discharged .

e. At 2:39 AM the RN documented restraints for violent behavior were initiated. The RN documented that Patient #1 threatened "physical harm toward staff" and "violent behavior toward self/property." The medical record lacked any documented evidence of these behaviors prior to 2:39 AM.

f. At 3:53 AM the RN documented in an ED Nursing Note "Patient refusing care. Security assisted with patient's blood glucose."

g. At 5:24 AM Staff C, physician, documented Patient #1 "had been fairly uncooperative here throughout the night, at first just refused anybody touch her, did not want any more blood drawn because we needed a comprehensive metabolic panel (CMP) on her, did not want her electrocardiogram (EKG) done. Then she escalated more to the point where she is threatening loud. So, for her protection, she was chemically and physically restrained."

h. At 6:03 AM the RN documented "patient taken out of restraints" and "patient walked to bathroom with one assist and security. Security at bedside." There was no assessment of Patient #1 after she was released from the restraints.

Review of the facility security policy 36 "Use of Restraints" revealed the purpose of the policy was "to provide a safe and secure environment for all patients, employees, visitors, and physicians by providing clear instruction for the application of physical and mechanical restraint." The policy also specified "security officers may utilize human restraints in cases in which there is an imminent risk of the patient harming themselves or others, including staff."

Review of the facility's policy "Restraint and Seclusion" revealed indications for the use of restraints for violent and self-destructive patients included, "biting, kicking, slapping, punching, choking, cutting, throwing objects AND alternatives including but not limited to de-escalation, time-out, verbal re-directions, and contract for safety have failed and are documented." This policy also addressed patient monitoring and assessment for the use of restraints which included an assessment every two hours while restrained and post restraint removal.

There was no documented evidence in Patient #1's medical record of the specified behaviors such as "biting, kicking, slapping, punching, choking, cutting, throwing objects" or the alternatives attempted "including but not limited to de-escalation, time-out, verbal re-directions, and contract for safety" to support the use of restraints and force.

From the initiation of restraints at 2:39 AM until the time of release at 6:03 AM, there was no evidence of the every two hour assessment and evaluation of vital signs, nutrition/hydration, range of motion, physical/psychological status, comfort, readiness for release from restraints, or injury related to use of restraints. There was also no renewal order for the continued use of the restraints after the initial two hour order lapsed per the facility's policy.

Review of the facility's complaint/grievance report, Helpline Report, revealed a complaint involving Patient #1 dated 02/24/17. The report identified the "issue" as "expresses concern regarding needs not being met."

At 11:35 AM on 02/24/17 Staff B, from Risk Management, interviewed Patient #1 regarding her "concerns." Per the documented interview, Patient #1 stated "I want to know my right about receiving water, walking around in my room and the training the guards have here and possibly two nurses."

Patient #1 asked why she could not have a cup in her room to fill with water at the sink as she liked. Patient #1 reported she had a "prolapsed bladder" and needed to go to the bathroom frequently. Staff B then told Patient #1 she "had been offered a drink of water eight times in the last hour and that a cup of water had not been provided to fill up in the sink due to refusal to use a bedside commode and the increased need to be walked to the bathroom every 15-20 minutes."

Patient #1 also verbalized to Staff B she had been "hog tied to my bed and the guards and possibly two nurses were all street fighter" on her. Patient #1 verbalized they used "pressure points" on her to which Staff B responded "guards are trained and that this was done to for the safety of herself and the staff involved."

Staff A was made aware of and confirmed these findings on 04/11/17 at 10:48 AM.


2. Review of the medical record for Patient #7 revealed the patient was admitted on [DATE] with diagnoses which included acute [DIAGNOSES REDACTED] and hyperactive delirium most likely due to an infectious process

Review of the security department's Investigative Report for the use of force dated 03/06/17 at 7:18 PM the command post received a call from the facility's 6 N nursing unit about a combative patient. Two facility security officers responded to the nursing unit. On arrival Patient #7 was partially out of the vest restraint and was now tangled in it. Nursing also informed them that every time they tried to put it back on him he would swing at them.

The two officers entered the patient's room and physically restrained Patient #7 while nursing re-applied the vest restraint. Upon the officers exiting of the patient's room, Patient #7 again tried to get out of the vest and officers again restrained the patient while nursing applied two point soft restraints and administered medication.

The next nursing documentation note on 03/06/17 at 7:15 PM revealed restraint documentation was initiated and a vest restraint order was received on 03/06/17 at 7:15 PM. The facility was unable to provide documentation the patient became entangled in the vest restraint or the need for the security staff to use force.

Review of the manufacturer's directions for use for the vest style body holder (i.e. vest restraint device) directed that this device was not designed for use on combative patients. The contraindications documented in bold ink "This Restraint" is not designed for use on combative patients.

Interview with Staff J confirmed the facility failed to follow their policy by utilizing a vest restraint on a combative patient and further failed to document the patient's entanglement in the device or the need for security to use force in the restraint process.

3. Review of the medical record revealed Patient #6 arrived in the emergency department of the facility on 01/26/17 and was seen by the emergency department physician at 5:25 PM. The emergency documentation completed by the physician documented Patient #6 had a history of [DIAGNOSES REDACTED] and seizure disorder, arrived at the facility with altered mental status. The medical record further documented the patient had recently been discharged from the hospital on [DATE] for breakthrough seizures.

Review of the emergency department nursing documentation failed to provide any documentation related to the patient's seizure activity or status. Additionally, the nursing assessment or other nursing documentation failed to document the use of force to physically restrain Patient #6. The facility was unable to provide a physician's order to physically restrain the patient.

Review of the facility's "Investigation Report" dated 01/26/17 for the use of force documented the ED had notified security of a combative patient. Two officers responded to the room and witnessed Patient #6 having seizure like symptoms. The patient had no control of his arms and swung multiple times. One officer controlled both of the patients arms while the second officer controlled the patients legs.

Review of the facility's "Clinical Nursing Skills Basic to Advanced Skills" directed under "Providing Safety for Clients with Seizure Activity, Do not restrain client or place anything in client's mouth: document findings."

These findings were confirmed during interview with Staff I on 04/12/17 at 12:43 PM.
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0161
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on medical record review, Investigation Report review, policy review, staff interview, and observations, the facility failed to ensure the medical record contained an order for restraints for four (Patient #3, #5, #8 and #9) of 18 medical records reviewed for restraint orders and three of three patients observed with bilateral hand mitts on (Rooms 3710, 3716 and 3717). This had the potential to affect the facility's 310 current patients.

Findings include:

The facility's Restraint and Seclusion policy was reviewed. The policy stated the following:
b. Physician Orders
A registered nurse may initiate restraint or seclusion in advance of the physician's order:
1. As soon as possible, but no longer than one hour after the initiation of restraint or seclusion, the registered nurse will consult with a responsible LIP about the patient's physical and psychological status and obtain an order (telephone or written).


1. The facility's Investigation Report from 01/08/17 at 11:29 PM regarding Patient #8 was reviewed. The report stated security command was called in reference to a patient that was trying to get out of bed. An officer responded to the room and observed four nurses holding down Patient #8. An officer held the left arm, while nursing staff removed intravenous tubing from Patient #8's hand. Another officer arrived shortly after and held the right arm and leg of Patient #8. Minimal effort was needed to keep Patient #8 in bed while nursing contacted a doctor and then medicated Patient #8.

The medical record for Patient #8 was reviewed. The record did not contain an order for the restraint of Patient #8.

These findings were shared with Staff A and Staff B on 04/13/17 at 12:33 PM.

2. An Investigation Report for Patient #9 was reviewed. The report revealed an officer was called to secure Patient #9 on 01/19/17 at 5:28 PM due to Patient #9 trying to leave the facility. An officer witnessed two nurses holding Patient #9 against a wall outside of the x-ray doors. The officer secured the "Escort" position and Patient #9 did not struggle against the officer as they proceeded to return to Patient #9's room.

The medical record for Patient #9 was reviewed and the record did not contain an order for the restraints.

These findings were shared with Staff A and Staff B on 04/13/17 at 12:33 PM.

3. Review of the medical record for Patient #5 revealed the patient was admitted to the hospital with diagnoses which included history of chronic obstructive pulmonary disease (COPD) and chronic respiratory failure who was dependent on home oxygen and BiPAP (Bi-level Positive Airway Pressure machine) during sleep. The patient was admitted to the hospital for an exacerbation of COPD which required intubation and mechanical breathing assistance (breathing tube). The nursing assessment and nursing documentation failed to document the use of any restraint type devices but did record the use of bilateral hand mitts. Observations on 04/12/17 at 9:15 AM and again at 2:11 PM revealed the patient was observed to have bilateral boxing glove style mitts on both hands.

Review of the manufacturers' printed directive for the Posey Peek-A-Boo Mitt revealed severe emotional, psychological, or physical problems may occur: if the device was uncomfortable, or severely limited movement. The reverse side of the directive referred to the device as a restraint and directed the need for a complete assessment of the patient to ensure restraint use was appropriate; use a restraint only when all other options have failed and to use the least restrictive device for the shortest time. Patients have a right to be free from restraint.

Interview with the spouse of Patient #5 on 04/11/17 at 10:17 AM revealed the patient was intubated in the emergency department on admission and doesn't like the tube down the throat but understood the need for it and was pretty good at directions and not touching the breathing equipment. The interview further revealed that the facility routinely kept the mitts on the patient to prevent removal or dislodgement of the breathing tube and other medical equipment and devices and that this was explained to the patient and the family.

4. Review of the medical record for Patient #3 revealed the patient was admitted on [DATE] with diagnosis which included COPD, history of seizures, and history of obstructive sleep apnea and the use of BiPap. Review of the medical record revealed the documentation failed to contain any mention of the use of restraints used with the patient.

However, observations during tour of the facility on 04/10/17 from 9:15 AM to 10:50 AM revealed Patient #3 was observed at 9:15 AM, 9:47 AM, and again at 2:11 PM to have full face-mask BiPAP in use and that both hands were in bulky boxer-glove style mitts.

Interview with Staff I on 04/13/17 at 3:55 PM confirmed there was no documentation in the medical record that revealed restraints were in use.

5. Tour of the facility's Medical Intensive Care Unit, MICU, was conducted on 04/11/17 at 9:18 AM with Staff K, unit director. At that time Staff K was asked for a list of patients on the unit who were currently restrained. After checking, Staff K stated there were currently no patients in restraints. Tour of the remainder of the unit revealed three patients with bilateral hand mitts on, in rooms 3710, 3716 and 3717.

Observation of the patient in room 3717 revealed he was alert and had bilateral hand mitts on.

Interview with his nurse, Staff L, revealed the patient had a history of dementia. Staff L was asked why the patient had the mitts on and stated to keep him from pulling out tubes. Staff L was asked how she decides when to use mitts or not to use them and stated they use mitts on patients who have tubes in place. Staff L was then asked how and when she was educated on the use of mitts and stated approximately two years ago the unit did a big education and switched from using other restraints to mitts.

Observation of the patient in room 3716 revealed he was alert. The patient was waving his arms in the air and shaking his hands, in an apparent attempt to get the mitts off. The patient began to rub the hand mitts together and against his body, again in an apparent attempt to remove them. The patient was unable to remove the hand mitts and unable to free his fingers from inside the flap.

The patient's nurse, Staff M, was then interviewed. Staff M stated the patient was alert but not oriented with a history of dementia. Staff M was asked if the patient tries to remove the mitts and confirmed yes. Staff M was asked why the mitts were on the patient and stated to keep the patient from pulling off his oxygen mask and from pulling out his foley catheter and IV.
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0167
Based on staff interview and observation, the facility failed to ensure the use of hand mitts was in accordance with a facility policy. This affected three of three patients observed in hand mitts (patients in rooms 3710, 3716 and 3717) with the potential to affect all 310 current patients.

Findings include:

On 04/13/17 at 12:55 PM Staff B confirmed the facility still does not consider hand mitts a restraint and there was no policy related to their use.

Tour of the facility's Medical Intensive Care Unit, MICU, was conducted on 04/11/17 at 9:18 AM with Staff K, unit director. At that time Staff K was asked for a list of patients on the unit who were currently restrained. After checking, Staff K stated there were currently no patients in restraints. Tour of the remainder of the unit revealed three patients with bilateral hand mitts on, in rooms 3710, 3716 and 3717.

Observation of the patient in room 3717 revealed he was alert and had bilateral hand mitts on.

Interview with his nurse, Staff L, revealed the patient had a history of dementia. Staff L was asked why the patient had the mitts on and stated to keep him from pulling out tubes. Staff L was asked how she decides when to use mitts or not to use them and stated they use mitts on patients who have tubes in place. Staff L was then asked how and when she was educated on the use of mitts and stated approximately two years ago the unit did a big education and switched from using other restraints to mitts.

Observation of the patient in room 3716 revealed he was alert. The patient was waving his arms in the air and shaking his hands, in an apparent attempt to get the mitts off. The patient began to rub the hand mitts together and against his body, again in an apparent attempt to remove them. The patient was unable to remove the hand mitts and unable to free his fingers from inside the flap.

The patient's nurse, Staff M, was then interviewed. Staff M stated the patient was alert but not oriented with a history of dementia. Staff M was asked if the patient tries to remove the mitts and confirmed yes. Staff M was asked why the mitts were on the patient and stated to keep the patient from pulling off his oxygen mask and from pulling out his foley catheter and IV.
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0168
Based on medical record review, policy review and staff interview, the facility failed to ensure the use of restraint was in accordance with the order of a physician or other licensed independent practitioner. This affected one of 18 medical records reviewed for restraint orders, Patient #1. This had the potential to affect all 310 current patients.

Findings include:

Facility policy Restraint and Seclusion was reviewed. Per policy for the use of restraints for violent and self-destructive patients, the following was specified:

b. Physician Orders
A registered nurse may initiate restraint or seclusion in advance of the physician's order:
i. As soon as possible, but no longer than one hour after the initiation of restraint or seclusion, the registered nurse will consult with a responsible LIP about the patient's physical and psychological status and obtain an order (telephone or written).
ii. The initial and all subsequent restrain orders shall expire in:
a) 1 hour or less for patients 8 years of age or younger
b) 2 hours for patients from 9 years of age and older


1. Review of Patient #1's medical record revealed an order for the use of restraints for "violent/self-destructive behavior" on 02/24/17 at 2:39 AM while she was in the ED (Emergency Department). At that time Patient #1 was placed in four point locked nylon restraints with the assistance of security staff, as documented on Investigation Report dated 02/24/17 at 2:32 AM. The order for the restraints had a two hour time limit. Patient #1 remained in the restraints for approximately three and one half hours, from 2:39 AM to 6:03 AM on 02/24/17. There was no documented evidence of an order for continued use of the restraints after the initial two hour order expired.

Review of Patient #1's medical record revealed she placed in four point locked nylon restraints (for violent behavior) while in the ED beginning on 03/16/17 at 10:15 PM and released on 03/17/17 at 8:30 AM as documented on a Restraint Visual Safety Check form. There was no documented order for the use of restraints.

Interview and review of the medical record with Staff A on 04/11/17 at 10:48 AM confirmed these findings. At that time Staff A stated the only time the Restraint Visual Safety Check form was utilized was when locked, nylon restraints were in place.

Staff A confirmed these findings on 04/11/17 at 10:48 AM.
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0175
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on observations, medical record review, facility policy and staff interview, the facility failed to monitor restrained patients. This affected two of 18 patients whose medical records were reviewed for timeliness of restraint monitoring, Patients' #1 and #2. This had the potential to affect all 310 current patients.

Findings include:

Review of facility policy Restraint and Seclusion revealed on page four of nine, under the heading of Monitoring, the following:
d. Assessment and documentation shall be performed approximately every 2 (two) hours, or more frequently if indicated by the condition or behavior of the patient. The patient shall be assessed for:

i. Signs or symptoms of distress
ii. Signs of any injury associated with the use of the restraint
iii. Nutrition and hydration needs
iv. Circulation
v. Range of motion
vi. Hygiene and elimination
vii. Physical and psychological status
viii. Comfort
ix. Readiness for discontinuation
x. Temporary removal from restraint
xi. Vital signs as indicated

Review of the hospital's restraint and seclusion training materials, which encompassed the facility's policy and procedure, directed in the Assessment and Documentation section that all patients in restraints or seclusion will be assessed and documented on approximately every two hours or more frequently if indicated by the condition or behavior of the patient. This applies to patients in restraints for non-violent or non-destructive behavior and to patients in restraints for violent or self-destructive behavior. Proper documentation is non-negotiable and failure to complete may be subject to disciplinary action.

1. Review of the medical record for Patient #1 revealed a visit to the ED on 02/23/17. At 2:39 AM on 02/24/17 the patient was placed in four point locked nylon restraints. From the initiation of restraints at 2:39 AM until the time of release at 6:03 AM, there was no evidence of the every two hour assessment and evaluation of vital signs, nutrition/hydration, range of motion, physical and psychological status, comfort, readiness for release from restraints, or injury related to use of restraints.

Patient #1 visited the ED again on 03/16/17. Per review of Investigation Report dated 03/16/17, at 8:51 PM security was called to the ED to "stand by." The responding officer arrived to the room and advised the command post "this is a patient that we have had as a standby in the past in which we had to restrain the patient. At 11:00 PM the physician ordered security to place the patient in 4 point nylon restraints.

Based on review of the Restraint Visual Safety Check form, Patient #1 remained in restraints until 8:30 AM on 03/17/17. There was no documented evidence of the every two hour assessment and evaluation of vital signs, nutrition/hydration, range of motion, physical and psychological status, comfort, readiness for release from restraints, or injury related to use of restraints.

Staff A confirmed these findings on 04/11/17 at 10:48 AM.

2. Review of the medical record for Patient #2 revealed the patient was admitted on [DATE] with chief complaint of falls and dizziness. The physician's order dated 04/08/17 for the time period between midnight and 7 AM directed the patient to have a soft limb restraint (soft wrist restraints) and the restraints to be checked every two hours for 24 hours. Review of the nursing flow sheet documentation dated 04/08/17 from midnight until 4:00 AM revealed no restraints checked had been conducted.

This finding was confirmed in interview with Staff Q on 04/10/17 at 3:23 PM
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0185
Based on medical record review, policy review and staff interview, the facility failed to ensure a description of the patient's behavior and the intervention used were documented in the medical record and were sufficient to support the intervention (s) used. This affected two of 18 medical records reviewed for use of restraints, Patients' #1 and #13. This had the potential to affect all 310 current patients.

Findings include:

Facility policy Restraint and Seclusion was reviewed. Per policy, indications for the use of restraints for violent and self-destructive patients included, "biting, kicking, slapping, punching, choking, cutting, throwing objects AND alternatives including but not limited to de-escalation, time-out, verbal re-directions, and contract for safety have failed and are documented."

The policy also specified at bullet point D, line 2, the following information was to be entered in the medical record: "Patient behavior that indicated clinical justification for restraint use."

1. Review of Patient #1's medical record revealed during a visit to the ED on 02/23/17 she was placed in four point nylon restraints on 02/24/17 at 2:39 AM and released at 6:03 AM. Review of the facility's "Investigation Report" dated 02/24/17 at 2:32 AM revealed security responded to an "incident" in the Emergency Department involving Patient #1.
According to this report on 02/24/17 at 2:30 AM Officer D was on a standby in room R-3. Physician C entered Patient #1's room to "address what was going on with her and the required test he will need done." Patient #1 stated she would not comply with any test or treatment. Physician C then advised her that "refusal was not an option." Patient #1 "began to argue with the doctor and he stated he was not going to change his mind and the test will be performed with or without her consent. He informed her that she would be restrained if she would not comply." Physician C then "turned to" Officer D and told Officer D "to have her restrained." Officer D proceeded to radio for additional help from security. Officer E, Officer F, Officer G and Officer H responded.
Further review of the report revealed Patient #1 "was very combative and it was necessary for the officers to apply pressure point and joint lock techniques to place the patient in four points. The nursing staff then ran the tests that were necessary." The Officers were then "cleared" at 3:00 AM without further incident.
The medical record lacked documentation of the above events.
Staff A confirmed these findings on 04/11/17 at 10:48 AM.

2. The facility's Investigation Report for Patient #13 was reviewed. The report revealed an officer was called on 01/04/17 at 6:08 PM for a suicidal patient (Patient #13). Patient #13 requested to use the bathroom and attempted to leave the facility. Patient #13 became hostile toward the officer and the officer had to use force to make Patient #13 cooperate and then escorted Patient #13 back to the room. The report stated that upon arrival to the room, Patient #13 began to be uncooperative and the officer had to use force again on Patient #13 at 6:22 PM.
The medical record of Patient #13 was reviewed. The record did not contain documentation of the above events.

The findings were shared with Staff A and Staff B on 04/13/17 at 12:33 PM.
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0186
Based on medical record review, staff interview and policy review, the facility failed to ensure alternatives or other less restrictive interventions attempted were documented in the medical record. This affected one of 18 medical records reviewed for use of restraints, Patient #1. This had the potential to affect all 310 current patients.

Findings include:

Review of Patient #1's medical record revealed during a visit to the ED (emergency department) on 02/23/17 she was placed in four point nylon restraints on 02/24/17 at 2:39 AM and released at 6:03 AM. The medical record lacked documented evidence of alternatives or other less restrictive interventions attempted.

Review of Patient #1's medical record revealed another visit to the ED on 03/16/17. Patient #1 was placed in four point nylon restraints on 03/16/17 at 10:15 PM and released on 03/17/17 at 8:30 AM as documented on a Restraint Visual Safety Check form. The medical record lacked documented evidence of alternatives or other less restrictive interventions attempted.

Staff A confirmed these findings on 04/11/17 at 10:48 AM.