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 CLAIR HOSPITAL 1000 BOWER HILL ROAD PITTSBURGH, PA 15243 April 17, 2015
VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING Tag No: A0144
Based on review of facility documentation, medical records (MR) and staff interviews (EMP), it was determined the facility failed to ensure care was provided in a safe setting for one of one medical record reviewed (MR1).

Findings include:

Review of "Patient Rights and Responsibilities" dated 2/24/15, revealed, " You have the right to receive care in a safe setting, free from verbal or physical abuse or harassment."
Review of facility policy "Restraints/Seclusion" dated 10/28/14, revealed, "The patient has the right to be free from restraints of any form that are not medically necessary are or used as a means of coercion, discipline, convenience or retaliation. The use of restraints/seclusion will only be instituted for emergent situations when alternative measures have not been effective to protect the patient or others from harm while maintaining the dignity, rights and wellbeing of the individual. Restraint is to be implemented in the lease restrictive manner and ended at the earliest possible time. "
1. Review of facility documentation revealed EMP13 stated, "I deployed my pepper foam gel which misfired. ... seeing what I was doing then took a step back and ran into the corner, I then deployed the spray again This time the gel did function properly. ... His hands had to be forced behind his back in order for the cuffs to be applied. They were double locked and checked for tightness and fit. He was then rolled onto his side, taken to room ten placed on the bed were leg restraints were applied first. Then cuffs were removed and hand restraints were applied."
2. Review of MR1 revealed "Focus note dated 3/9/15, at 15:43 ... Per MHRN (mental health registered nurse) ..., pt (patient) was aggressive w/ (with) staff in ED (Emergency Department last PM and was subsequently subdued w/ pepper spray foam by HPO(Hospital Police Officer) and placed in locked restraints."
3. Interview with EMP4 on 3/16/15, at approximately 10:30 AM revealed "This is the first incident pepper spray was used on a patient. ... My understanding is they used handcuffs."
4. Review of a security tape revealed the police officer pepper spraying the patient. Further review revealed the patient walking into the room with handcuffs on and sit on the bed.
Interview with EMP6 on 3/16/15, at approximately 12:00 PM revealed "The patient was getting very agitated. I never seen someone pepper sprayed before. The nurses usually verbalize with them (patients) I like to talk with them and offer medication to help calm them down. My plan was to place him in restraints and give Geodon and then maybe some Ativan. I wasn't aware he was peppered spray until after the fact."
VIOLATION: USE OF RESTRAINT OR SECLUSION Tag No: A0154
Based on review of facility documents and medical records (MR) and staff interviews (EMP), it was determined the facility failed to ensure the type or technique of restraint or seclusion used was the least restrictive intervention for one of one medical record reviewed (MR1).

Findings include:

Review of Patient Rights and Responsibilities, dated 2/24/15, revealed, "You have the right to receive care in a safe setting, free from verbal or physical abuse or harassment."
Review of facility policy, Restraints/Seclusion, dated 10/28/14, revealed, "The patient has the right to be free from restraints of any form that are not medically necessary are or used as a means of coercion, discipline, convenience or retaliation. The use of restraints/seclusion will only be instituted for emergent situations when alternative measures have not been effective to protect the patient or others from harm while maintaining the dignity, rights and well being of the individual. Restraint is to be implemented in the lease restrictive manner and ended at the earliest possible time. ... 6. Exceptions to restraints: The following situations are not considered restraint interventions: ...c. The use of handcuffs or other restrictive devices applied by law enforcement officials who are not employees of the hospital for custody, detention, and public safety. ... "
1. Review of facility documentation revealed "I deployed my pepper foam gel which miss fired. ... seeing what I was doing then took a step back and ran into the corner, I then deployed the spray again This time the gel did function properly. ... His hands had to be forced behind his back in order for the cuffs to be applied. They were double locked and checked for tightness and fit. He was then rolled onto his side, taken to room ten placed on the bed were leg restraints were applied first. Then cuffs were removed and hand restraints were applied."
2. Review of MR1 revealed "Focus note dated 3/9/15, at 15:43 ... Per MHRN(mental health registered nurse) ..., pt was aggressive w(with)/ staff in ED(Emergency Department last PM and was subsequently subdued w/ pepper spray foam by HPO(Hospital Police Officer) and placed in locked restraints."
3. Interview with EMP4 on 3/16/15, at approximately 10:30 AM revealed "This is the first incident pepper spray was used on a patient. ... My understanding is they used handcuffs."
4. Review of a security tape revealed the police officer pepper spraying the patient. Further review revealed the patient walking into the room with handcuffs on and sat on the bed.
5. Interview with EMP6 on 3/16/15, at approximately 12:00 PM revealed "The patient was getting very agitated. I never seen someone pepper sprayed before. I wasn't aware he was peppered spray until after the fact."
VIOLATION: FORM AND RETENTION OF RECORDS Tag No: A0438
Based on review of facility documents and medical records (MR) and staff interviews (EMP), it was determined the facility failed to ensure that nursing documentation was pertinent, accurate and concise in order to contribute to the continuity of patient care for one of one medical record reviewed (MR1).

Findings include:

Review of facility policy "Documentation" dated 9/24/14, revealed "The Nursing Process is reflected in the documentation system used in all patient care areas. Assessment, identification of patient problems, planning, implementation of interventions, and evaluation of patient status/progress toward desired outcomes are recorded on an ongoing basis and is a permanent part of the patients' medical record."

Review of facility documentation "Documentation Grid Minimum Requirements" dated 4/2014, revealed "Complete Physical Assessment ... Every shift (4,8 or 12 hours) With any status change ... Includes: ... Skin (must include wound assessment and measurement if applicable on admission ... Every shift (4,8 or 12 hours)."
Review of facility policy Assessment/Reassessment of Patient Care, dated 10/28/14, revealed, "...The goal of assessment is to determine the appropriate care, treatment and services to meet a patient's initial needs as well as his or her changing needs while in the setting ... 3. The need for further assessment is determined by the: -treatment setting - patient's condition - treatment the patient is seeking - response to treatment. 4. Each patient's status is periodically reassessed to determine the response to treatment, when a significant change occurs in the patient's condition or when there is a change in the patient's diagnosis. The reassessment interval is defined in department policy (e.g., the General Nursing Standards Manual)."
Review of facility policy GNSM (General Nursing Standards Manual) - Assessment/Reassessment of Inpatients, reviewed 9/2014, revealed, "... Analysis of all assessment data will provide the information necessary to identify, prioritize, and make decisions concerning patient's care and needs. ... A head to toe physical assessment consists of the following systems: ... skin. ... This should be completed every shift for the first 24 hours then every day. ... Patients should also be reassessed when there is a significant change in the patient's condition or diagnosis, and upon transfer and discharge."
Review of patient Safety and Occurrence Reporting dated 4/22/14, revealed "Medical Record Documentation: If a medical record exists, document a factual synopsis of the occurrence, physical assessment and observations, all treatment interventions and the individual's response to the treatment and/or diagnostic results."
Review of Manufacture instructions revealed "First Aid ... 2. Flush contaminated areas with large quantitates of cool water or diluted baking soda solution and expose to fresh air as soon as possible after arrest if effected. Caution failure to follow this instruction may result in severe skin irritation. Skin depigmentation or other skin injury."
1. Interview with EMP11 on 3/16/15, at approximately 12:15PM revealed, "I don't know if the pepper spray got in his eyes, most of the spray was on the left side of his face, left arm, neck and left rib area. Yes it [skin] was red from the pepper spray."
2. Review of MR1 revealed no documentation of the incident with pepper spray and handcuffs in the ED. Further review revealed nurses documentation "03-08-2015 21:18 since pt bathed skin now very reddened. Further review revealed no documentation of another skin assessment before leaving the Emergency Department or upon admission to 4E and before discharge from 4E".
Interview with EMP2 on 3/16/15, at approximately 1:37 PM confirmed the above findings and revealed "I don't see it [documentation of a skin assessment]. I would expect to see some documentation."
Interview with EMP3 on 3/16/15, at approximately 1:42 PM confirmed the above findings and revealed "It doesn't look like they put that [skin assessment] in."