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.

SHANNON MEDICAL CENTER 120 EAST HARRIS AVENUE SAN ANGELO, TX 76903 Feb. 24, 2015
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0168
Based on review of documentation and interview, it was determined that Patient # 1 was restrained with a vest restraint on 6/10/13 without a physician order.

Findings were:

Facility document entitled "Restraint (Use of) or Seclusion (Use of) Policy" stated in part
"All patients have the right to be free from physical or mental abuse, and corporal punishment. All patients have the right to be free from restraint or seclusion, of any form, imposed as means of convenience, or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member, or others and must be discontinued at the earliest possible time.

The use of restraint or seclusion is limited to those situations for which there is adequate and appropriate clinical justification.
? The use of restraint or seclusion is based on the assessed needs of the patient. Restraint or seclusion may only be used when less restrictive interventions have been determined to be ineffective to protect the patient, a staff member or others from harm.

...ORDERS FOR RESTRAINT FOR SAFETY/NON VIOLENT/ NON SELF DESTRUCTIVE BEHAVIOR: Orders obtained in accordance with this policy to address a patient's medical care-related needs (safety) that are evidenced by non-violent or non-destructive behavior (non-behavioral restraint) are considered in full force and effect for up to two calendar days-which includes the day the order was obtained. If the patient remains in restraint for more than two consecutive calendar days, then a new order must be obtained."

Patient # 1 was restrained with soft right and left wrist restraints from 6/6/13 through 6/10/13. Patient was restrained for medical safety (confused, pulling out IVs and Foley) and had daily physician orders and justification for restraints. On 6/10/13 Speech Therapy and Physical Therapy progress notes documented vest restraints. No order was found in the medical record of Patient # 1 for a vest restraint.

In an interview with the Quality Resources Director on 2/24/15, it was acknowledged that Patient # 1 was restrained with a vest restraint without a physician order.