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.
| MONUMENT HEALTH RAPID CITY HOSPITAL | 353 FAIRMONT BLVD POST OFFICE BOX 6000 RAPID CITY, SD 57701 | Aug. 19, 2015 |
| VIOLATION: PATIENT RIGHTS | Tag No: A0115 | |
| Based on record review, interview, and policy review, the provider failed to ensure one of one sampled (13) patient who had been restrained had: *A physician's order for restraints. *The care plan reviewed and revised regarding the use of restraints. *A face-to-face assessment within one hour of the application of the restraint by a licensed independent person (LIP). *Documentation for the appropriateness of the type of restraint, techniques used to de-escalate, and the restraint used had not been completed by a LIP or the RN. *Trained staff for the use of a take-down (taken down to the floor and held there) restraint for patient 13. 1. Review of patient 13's complete medical record for her 6/8/15 through 6/15/15 hospitalization revealed she had been physically restrained on 6/9/15 and on 6/14/15. Her patient rights had been violated during an improper restraint. Refer to A166, A168, A179, A184, A185, A186, and A188. |
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| VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION | Tag No: A0166 | |
| Based on record review, interview, and policy review, the provider failed to ensure one of one sampled (13) patient's care plan had been updated after a restraint had been used. Findings include: 1. Review of patient 13's complete medical record for her 6/8/15 through 6/15/15 hospitalization revealed her care plan had not been updated for the use of restraints. She had been restrained on 6/9/15 and 6/14/15. Interview on 8/19/15 at 2:30 p.m. with registered nurse/managers A and C confirmed patients 13's care plan had not been updated regarding restraints. Review of the provider's revised October 2014 Restraint and Seclusion Use policy revealed no procedure for updating the patient's care plan. Review of the provider's revised October 2014 Nursing Process policy revealed: *"As the patient's condition changes, new problems may be identified and resolved." *Documentation: -"Use appropriate Restraint/Assessment Flow Sheet, or PCS [electronic documentation program] documentation to document clinical justification, less restrictive means utilized, ongoing monitoring and assessments." -"Document the monitoring/check, any early release/reapplication and patient/family education information on the restraint flow sheet or in PCS documentation." -"Add the restraint intervention to the patient's plan of care/profile." -"All events, alternative, and less restrictivve measures preceding the restraint/seclusion application will be completed." |
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| VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION | Tag No: A0168 | |
| Based on record review, interview, and policy review, the provider failed to ensure one of one sampled (13) patient had a physician's order for the use of a restraint. Findings include: 1. Review of patient 13's complete medical record for her 6/8/15 through 6/15/15 hospitalization revealed: *On 6/9/15 at 9:09 a.m. an activity progress note stated patient 13 had started yelling and swearing. Other patients were sent to their rooms, and a show of staff and take down were needed. *On 6/14/15 at 4:25 p.m. a progress note by psych (psychiatric) technician (PT) D revealed: -"Towards end of shift heard pt. [patient] gasp, pt. looked like she was choking, asked pt if she was choking, pt. made gesture as tho [though] she was, went to pt. but pt. was getting air, called nurse, observed pt. for air exchange, pt began to foam at mouth, staff thought maybe pt. was having seizure, pt eyes rolled back in head then pt. went limp, pt. continued to maintain airway and pink skin color." -"Pt. then came out of state, crying and sobbing. Pt. stated that she had choked herself and scratched herself." -"Asked pt. what she choked herself with and she said she didn't want to say, saw ripped armband on table, asked pt. if she used that and pt. said yes." -"Pt. began to yell and scream at staff saying she hates this place, hates the staff, calling them "f'ing" "niggers" and "bitches", that we don't care about her, etc." -Pt. was told by nurse that she needed to go to time out at which time pt. attacked nurse [registered nurse RN E], staff went to assist, pt. attacked another staff member, _____ [name of PT B]." -"_______ [Name of PT B] was able to take pt. to ground and pt. was restrained by _____[names of PT B, RN E, and PT D] until help could come." -"Pt. calmed down after incident and walked back to time out." *Review of patient 13's physician's orders revealed no physician order for either restraint. Interview on 8/19/15 at 2:30 p.m. with RN/nurse managers A and C confirmed: *No physician's order had been obtained for either of the days the restraint had been used. *They had not treated it as a restraint, as staff had not been trained on taking a patient down and holding them there. *They agreed patient 13 had been restrained two times, and a physician's order should have been obtained. Review of the provider's revised October 2014 Restraint and Seclusion use policy revealed: *Violent/Self-Destructive Restraints and Seclusion: -"The decision to restrain/seclude a patient is made by the LIP [licensed independent practitioner]." -"In emergency situations when the LIP is not present and restraint/seclusion is required to manage the unanticipated behavior of a violent of aggressive patient, RNs or a Behavioral Health staff member having demonstrated this competence, may make the decision to use restraint/seclusion, and then the RN immediately notifies the LIP, and obtains a verbal order for restraint/seclusion." |
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| VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION | Tag No: A0179 | |
| Based on record review, interview, and policy review, the provider failed to ensure one of one sampled (13) patient had been assessed within one hour of a restraint having been used. Findings include: 1. Review of patient 13's complete medical record for her 6/8/15 through 6/15/15 hospitalization revealed: *On 6/9/15 at 9:09 a.m. an activity progress note stated patient 13 had started yelling and swearing. Other patients were sent to their rooms, and a show of staff and take down were needed. *On 6/14/15 at 4:25 p.m. a progress note by psych (psychiatric) technician (PT) D revealed: -"Towards end of shift heard pt. [patient] gasp, pt. looked like she was choking, asked pt if she was choking, pt. made gesture as tho [though] she was, went to pt. but pt. was getting air, called nurse, observed pt. for air exchange, pt began to foam at mouth, staff thought maybe pt. was having seizure, pt eyes rolled back in head then pt. went limp, pt. continued to maintain airway and pink skin color." -"Pt. then came out of state, crying and sobbing. Pt. stated that she had choked herself and scratched herself." -"Asked pt. what she choked herself with and she said she didn't want to say, saw ripped armband on table, asked pt. if she used that and pt. said yes." -"Pt. began to yell and scream at staff saying she hates this place, hates the staff, calling them "f'ing" "niggers" and "bitches", that we don't care about her, etc." -Pt. was told by nurse that she needed to go to time out at which time pt. attacked nurse [registered nurse RN E], staff went to assist, pt. attacked another staff member, _____ [name of PT B]." -"_______ [Name of PT B] was able to take pt. to ground and pt. was restrained by _____[names of PT B, RN E, and PT D] until help could come." -"Pt. calmed down after incident and walked back to time out." *Review of patient 13's additional progress documentation revealed no face-to-face assessment had occurred after either restraint. Interview on 8/19/15 at 2:30 p.m. with RN/nurse managers A and C confirmed: *Patient 13 had been restrained two times and a physician's order should have been obtained for a take down and hold type of restraint. *No face-to-face assessment had been documented as having been completed within one hour of the restraint. Review of the provider's revised October 2014 Restraint and Seclusion use policy revealed: *Violent/Self-Destructive Restraints and Seclusion: -"The decision to restrain/seclude a patient is made by the LIP [licensed independent practitioner]." -"In emergency situations when the LIP is not present and restraint/seclusion is required to manage the unanticipated behavior of a violent of aggressive patient, RNs or a Behavioral Health staff member having demonstrated this competence, may make the decision to use restraint/seclusion, and then the RN immediately notifies the LIP, and obtains a verbal order for restraint/seclusion." -"When restraint or seclusion is used for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member, or others, the patient must be seen face-to-face within 1 hour after the initiation of the intervention." -The face-to-face could have been completed by the physician or other LIP or an RN who had demonstrated competence. |
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| VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION | Tag No: A0184 | |
| Based on record review, interview, and policy review, the provider failed to ensure one of one sampled (13) patient had documentation of having been assessed within one hour of a restraint having been used. Findings include: 1. Review of patient 13's complete medical record for her 6/8/15 through 6/15/15 hospitalization revealed: *On 6/9/15 at 9:09 a.m. an activity progress note stated patient 13 had started yelling and swearing. Other patients were sent to their rooms, and a show of staff and take down were needed. *On 6/14/15 at 4:25 p.m. a progress note by psych (psychiatric) technician (PT) D revealed: -"Towards end of shift heard pt. [patient] gasp, pt. looked like she was choking, asked pt if she was choking, pt. made gesture as tho [though] she was, went to pt. but pt. was getting air, called nurse, observed pt. for air exchange, pt began to foam at mouth, staff thought maybe pt. was having seizure, pt eyes rolled back in head then pt. went limp, pt. continued to maintain airway and pink skin color." -"Pt. then came out of state, crying and sobbing. Pt. stated that she had choked herself and scratched herself." -"Asked pt. what she choked herself with and she said she didn't want to say, saw ripped armband on table, asked pt. if she used that and pt. said yes." -"Pt. began to yell and scream at staff saying she hates this place, hates the staff, calling them "f'ing" "niggers" and "bitches", that we don't care about her, etc." -Pt. was told by nurse that she needed to go to time out at which time pt. attacked nurse [registered nurse {RN}E], staff went to assist, pt. attacked another staff member, _____ [name of PT B]." -"_______ [Name of PT B] was able to take pt. to ground and pt. was restrained by _____[names of PT B, RN E, and PT D] until help could come." -"Pt. calmed down after incident and walked back to time out." *Review of patient 13's additional progress documentation revealed no face-to-face assessment had been occurred after either restraint. Interview on 8/19/15 at 2:30 p.m. with RN/nurse managers A and C confirmed: *Patient 13 had been restrained two times and a physician's order should have been obtained for a take down and hold type of restraint. *No face-to-face assessment had been documented as having been completed within one hour of the restraint. Review of the provider's revised October 2014 Restraint and Seclusion use policy revealed: *Violent/Self-Destructive Restraints and Seclusion: -"The decision to restrain/seclude a patient is made by the LIP [licensed independent practitioner]." -"In emergency situations when the LIP is not present and restraint/seclusion is required to manage the unanticipated behavior of a violent of aggressive patient, RNs or a Behavioral Health staff member having demonstrated this competence, may make the decision to use restraint/seclusion, and then the RN immediately notifies the LIP, and obtains a verbal order for restraint/seclusion." -"When restraint or seclusion is used for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member, or others, the patient must be seen face-to-face within 1 hour after the initiation of the intervention." -The face-to-face could have been completed by the physician or other LIP or an RN who had demonstrated competence. *Documentation: -"Use appropriate Restraint/Assessment Flow Sheet, or PCS [electronic documentation program] documentation to document clinical justification, less restrictive means utilized, ongoing monitoring and assessments." -"Document the monitoring/check, any early release/reapplication and patient/family education information on the restraint flow sheet or in PCS documentation." -"Add the restraint intervention to the patient's plan of care/profile." -"All events, alternative, and less restrictive measures preceding the restraint/seclusion application will be completed." |
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| VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION | Tag No: A0185 | |
| Based on record review, interview, and policy review, the provider failed to ensure one of one sampled (13) patient had documentation of: *Behaviors she had displayed. *Techniques used to de-escalate her behaviors. *The restraint used. *Two of two restraints by a LIP or the RN. Findings include: 1. Review of patient 13's complete medical record for her 6/8/15 through 6/15/15 hospitalization revealed: *On 6/9/15 at 9:09 a.m. an activity progress note stated patient 13 had started yelling and swearing. Other patients were sent to their rooms, and a show of staff and take down were needed. *On 6/14/15 at 4:25 p.m. a progress note by psych (psychiatric) technician (PT) D revealed: -"Towards end of shift heard pt. [patient] gasp, pt. looked like she was choking, asked pt if she was choking, pt. made gesture as tho [though] she was, went to pt. but pt. was getting air, called nurse, observed pt. for air exchange, pt began to foam at mouth, staff thought maybe pt. was having seizure, pt eyes rolled back in head then pt. went limp, pt. continued to maintain airway and pink skin color." -"Pt. then came out of state, crying and sobbing. Pt. stated that she had choked herself and scratched herself." -"Asked pt. what she choked herself with and she said she didn't want to say, saw ripped armband on table, asked pt. if she used that and pt. said yes." -"Pt. began to yell and scream at staff saying she hates this place, hates the staff, calling them "f'ing" "niggers" and "bitches", that we don't care about her, etc." -Pt. was told by nurse that she needed to go to time out at which time pt. attacked nurse [registered nurse RN E], staff went to assist, pt. attacked another staff member, _____ [name of PT B]." -"_______ [Name of PT B] was able to take pt. to ground and pt. was restrained by _____[names of PT B, RN E, and PT D] until help could come." -"Pt. calmed down after incident and walked back to time out." *Review of patient 13's additional progress documentation revealed no face-to-face assessment had been occurred after either restraint. Interview on 8/19/15 at 2:30 p.m. with RN/nurse managers A and C confirmed: *Documentation of patient 13's behaviors, techniques that had been used to de-escalate her behaviors, and the type of restraint used had not been completed by a LIP or the RN. *The RN/Nurse manager had documented on the first restraint. *PT D had documented on the second restraint. *Neither of the above restraint times had included all of the required documentation. Review of the provider's revised October 2014 Restraint and Seclusion use policy revealed: *Violent/Self-Destructive Restraints and Seclusion: -"The decision to restrain/seclude a patient is made by the LIP [licensed independent practitioner]." -"In emergency situations when the LIP is not present and restraint/seclusion is required to manage the unanticipated behavior of a violent of aggressive patient, RNs or a Behavioral Health staff member having demonstrated this competence, may make the decision to use restraint/seclusion, and then the RN immediately notifies the LIP, and obtains a verbal order for restraint/seclusion." -"When restraint or seclusion is used for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member, or others, the patient must be seen face-to-face within 1 hour after the initiation of the intervention." -The face-to-face could have been completed by the physician or other LIP or an RN who had demonstrated competence. *Documentation: -"Use appropriate Restraint/Assessment Flow Sheet, or PCS [electronic documentation program] documentation to document clinical justification, less restrictive means utilized, ongoing monitoring and assessments." -"Document the monitoring/check, any early release/reapplication and patient/family education information on the restraint flow sheet or in PCS documentation." -"Add the restraint intervention to the patient's plan of care/profile." -"All events, alternative, and less restrictive measures preceding the restraint/seclusion application will be completed." |
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| VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION | Tag No: A0186 | |
| Based on record review, interview, and policy review, the provider failed to ensure one of one sampled (13) patient had documentation of any de-esclation techniques used before the restraint had been applied. This had not been done by a LIP or the RN for two of two restraints. Findings include: 1. Review of patient 13's complete medical record for her 6/8/15 through 6/15/15 hospitalization revealed: *On 6/9/15 at 9:09 a.m. an activity progress note stated patient 13 had started yelling and swearing. Other patients were sent to their rooms, and a show of staff and take down were needed. *On 6/14/15 at 4:25 p.m. a progress note by psych (psychiatric) technician (PT) D revealed: -"Towards end of shift heard pt. [patient] gasp, pt. looked like she was choking, asked pt if she was choking, pt. made gesture as tho [though] she was, went to pt. but pt. was getting air, called nurse, observed pt. for air exchange, pt began to foam at mouth, staff thought maybe pt. was having seizure, pt eyes rolled back in head then pt. went limp, pt. continued to maintain airway and pink skin color." -"Pt. then came out of state, crying and sobbing. Pt. stated that she had choked herself and scratched herself." -"Asked pt. what she choked herself with and she said she didn't want to say, saw ripped armband on table, asked pt. if she used that and pt. said yes." -"Pt. began to yell and scream at staff saying she hates this place, hates the staff, calling them "f'ing" "niggers" and "bitches", that we don't care about her, etc." -Pt. was told by nurse that she needed to go to time out at which time pt. attacked nurse [registered nurse RN E], staff went to assist, pt. attacked another staff member, _____ [name of PT B]." -"_______ [Name of PT B] was able to take pt. to ground and pt. was restrained by _____[names of PT B, RN E, and PT D] until help could come." -"Pt. calmed down after incident and walked back to time out." *Neither of the above restraint times had included all the required documentation. Review of the provider's revised October 2014 Restraint and Seclusion use policy revealed: *Violent/Self-Destructive Restraints and Seclusion: -"The decision to restrain/seclude a patient is made by the LIP [licensed independent practitioner]." -"In emergency situations when the LIP is not present and restraint/seclusion is required to manage the unanticipated behavior of a violent of aggressive patient, RNs or a Behavioral Health staff member having demonstrated this competence, may make the decision to use restraint/seclusion, and then the RN immediately notifies the LIP, and obtains a verbal order for restraint/seclusion." -"When restraint or seclusion is used for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member, or others, the patient must be seen face-to-face within 1 hour after the initiation of the intervention." -The face-to-face could have been completed by the physician or other LIP or an RN who had demonstrated competence. *Documentation: -"Use appropriate Restraint/Assessment Flow Sheet, or PCS [electronic documentation program] documentation to document clinical justification, less restrictive means utilized, ongoing monitoring and assessments." -"Document the monitoring/check, any early release/reapplication and patient/family education information on the restraint flow sheet or in PCS documentation." -"Add the restraint intervention to the patient's plan of care/profile." -"All events, alternative, and less restrictive measures preceding the restraint/seclusion application will be completed." |
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| VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION | Tag No: A0188 | |
| Based on record review, interview, and policy review, the provider failed to ensure one of one (13) patient had documentation of the response to the use of the restraints. Findings include: 1. Review of patient 13's complete medical record for her 6/8/15 through 6/15/15 hospitalization revealed: *On 6/9/15 at 9:09 a.m. an activity progress note stated patient 13 had started yelling and swearing. Other patients were sent to their rooms, and a show of staff and take down were needed. *On 6/14/15 at 4:25 p.m. a progress note by psych (psychiatric) technician (PT) D revealed: -"Towards end of shift heard pt. [patient] gasp, pt. looked like she was choking, asked pt if she was choking, pt. made gesture as tho [though] she was, went to pt. but pt. was getting air, called nurse, observed pt. for air exchange, pt began to foam at mouth, staff thought maybe pt. was having seizure, pt eyes rolled back in head then pt. went limp, pt. continued to maintain airway and pink skin color." -"Pt. then came out of state, crying and sobbing. Pt. stated that she had choked herself and scratched herself." -"Asked pt. what she choked herself with and she said she didn't want to say, saw ripped armband on table, asked pt. if she used that and pt. said yes." -"Pt. began to yell and scream at staff saying she hates this place, hates the staff, calling them "f'ing" "niggers" and "bitches", that we don't care about her, etc." -Pt. was told by nurse that she needed to go to time out at which time pt. attacked nurse [registered nurse RN E], staff went to assist, pt. attacked another staff member, _____ [name of PT B]." -"_______ [Name of PT B] was able to take pt. to ground and pt. was restrained by _____[names of PT B, RN E, and PT D] until help could come." -"Pt. calmed down after incident and walked back to time out." *Review of patient 13's additional progress documentation revealed no face-to-face assessment had been occurred after either restraint. The documentation had not contained any description of her response to the intervention by a LIP or RN. Interview on 8/19/15 at 2:30 p.m. with RN/nurse managers A and C confirmed: *Documentation of patient 13's behaviors, techniques that had been used to de-escalate her behaviors, and the type of restraint used had not been completed by a LIP or the RN. *The RN/Nurse manager had documented on the first restraint. *PT D had documented on the second restraint. *Neither of the above restraint times had included all of the required documentation. Review of the provider's revised October 2014 Restraint and Seclusion use policy revealed: *Violent/Self-Destructive Restraints and Seclusion: -"The decision to restrain/seclude a patient is made by the LIP [licensed independent practitioner]." -"In emergency situations when the LIP is not present and restraint/seclusion is required to manage the unanticipated behavior of a violent of aggressive patient, RNs or a Behavioral Health staff member having demonstrated this competence, may make the decision to use restraint/seclusion, and then the RN immediately notifies the LIP, and obtains a verbal order for restraint/seclusion." -"When restraint or seclusion is used for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member, or others, the patient must be seen face-to-face within 1 hour after the initiation of the intervention." -The face-to-face could have been completed by the physician or other LIP or an RN who had demonstrated competence. *Documentation: -"Use appropriate Restraint/Assessment Flow Sheet, or PCS [electronic documentation program] documentation to document clinical justification, less restrictive means utilized, ongoing monitoring and assessments." -"Document the monitoring/check, any early release/reapplication and patient/family education information on the restraint flow sheet or in PCS documentation." -"Add the restraint intervention to the patient's plan of care/profile." -"All events, alternative, and less restrictive measures preceding the restraint/seclusion application will be completed." |
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