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.

Intakes: TN 711
Based on interview, policy review and medical record review, it was determined the facility failed to maintain patient rights to be free from restraints for 1 of 2 patients reviewed (Patient #1) who was placed in restraints.

The findings included:
1. Interviews with facility staff revealed Patient #1 was restless, trying to get out of bed and pulling out his IVs at least one day prior to being placed in restraints.

2. Review of the restraint policy revealed a physician's order was to be obtained that was time-limited and stated the reason for the restraints. Per facility policy the order needed to be renewed every calendar day. The policy further stated the need for restraints would be based on assessments of the risk of the patient interfering with medical treatment. The policy offered several possible interventions for nursing staff to take that were less restrictive before placing a patient in restraints.

3. Medical record review for Patient #1 revealed the patient had been admitted from the emergency room (ER) after complaining of diarrhea, weakness, lethargy and not feeling well for several days. A Computerized Tomography (CT) scan done in the ER revealed the patient had a "...collapse of the left lung with a larger lung mass". The patient was admitted for treatment of diarrhea, metastatic mediastinal adenopathy, possible pneumonia and left-sided pleural effusion. Patient #1 became hypoxic developed tachypnea and sinus tachycardia and was transferred to the Intensive Care Unit (ICU) for closer observation. ICU nursing notes documented Patient #1 had pulled out an intravenous (IV) line while in ICU and refused breathing treatments. On the third day the patient was transferred to a general floor. Nursing notes documented he pulled out another IV, was restless and trying to get out of bed.

On 3/5/13 at 6:00 AM an order was obtained to place Patient #1 in restraints after noting he was pulling out IVs and attempting to ambulate. There was minimal documentation available for review to show what less restrictive interventions were used prior to placing the patient in restraints. Documentation revealed the family was at Patient #1's bedside by 9:00 AM and requested all IVs be discontinued at 1:30 PM. There was no documentation of the reasons for the continued use of restraints. The medical record review failed to document the continuing need for restraints after treatment and medications were terminated or after IVs were discontinued at 1:30 PM on 3/5/13. Nor was there documentation less restrictive interventions were being tried.