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INTERMOUNTAIN HOSPITAL 303 NORTH ALLUMBAUGH STREET BOISE, ID 83704 Oct. 17, 2013
VIOLATION: MEDICAL RECORD SERVICES Tag No: A0450
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of medical records, review of policies and staff interview, it was determined the hospital failed to ensure verbal orders were signed within 24 hours for 3 of 5 patients (#7, #8 and #12) whose records were reviewed and contained restraint or seclusion orders. This failure resulted in a lack of authentication of physician orders. Findings include:

The hospital's "Medical Staff Rules and Regulations," revised July 2010, stated orders for restraint or seclusion would "be signed by the physician within 24 hours of initiation...." In addition, the "SECLUSION/PHYSICAL RESTRAINT/EMERGENCY USE OF MEDICATION PHYSICIAN ORDER FORM" included a line for the physician to sign and documented "Must be signed within 24 hours of order given." The hospital failed to adhere to the medical staff rules as follows:

1. Patient #8 was [AGE] year old female admitted on [DATE] for alcohol detoxification. She was discharged from the hospital on [DATE].

Her medical record contained a "SECLUSION/PHYSICAL RESTRAINT/EMERGENCY USE OF MEDICATION PHYSICIAN ORDER FORM," which documented a telephone order was received from the physician on 1/24/13 at 3:30 AM, for the use of physical restraint, seclusion, Haldol 10 mg IM and Benadryl 50 mg IM. The physician authenticated the order on 2/16/13 at 1:43 PM, 23 days later.

The DON reviewed the record and was interviewed on 10/16/13 beginning at 1:35 PM. She confirmed the physician had not authenticated the orders within 24 hours in accordance with medical staff rules.

2. Patient #12 was a [AGE] year old male admitted on [DATE] with a diagnosis of schizoaffective disorder. He was discharged from the hospital on [DATE]. His medical record contained the following:

a. A "SECLUSION/PHYSICAL RESTRAINT/EMERGENCY USE OF MEDICATION PHYSICIAN ORDER FORM" documented a telephone order was received from the physician on 4/15/13 at 10:50 AM, for the use of physical restraint and 50 mg of Benadryl to be given IM. The physician authenticated the order on 4/17/13 at 9:00 AM.

b. A "SECLUSION/PHYSICAL RESTRAINT/EMERGENCY USE OF MEDICATION PHYSICIAN ORDER FORM" documented a telephone order was received from the physician on 4/15/13 at 7:29 PM, for the use of seclusion and Geodon 20 mg IM for psychosis. The physician authenticated the order on 4/17/13 at 9:00 AM.

The DON reviewed the record and was interviewed on 10/16/13 beginning at 1:35 PM. She confirmed the physician had not authenticated the orders within 24 hours in accordance with medical staff rules.

3. Patient #7 was a [AGE] year old female admitted on [DATE] with diagnoses of episodic mood disorder, dementia and suicidal ideation. She was discharged from the hospital on [DATE]. Her medical record contained the following:

a. A "SECLUSION/PHYSICAL RESTRAINT/EMERGENCY USE OF MEDICATION PHYSICIAN ORDER FORM" documented a telephone order was received from the physician on 7/24/13 at 3:10 PM, for the use of physical restraint. The physician authenticated the order on 7/26/13 at 12:24 PM.

b. A "SECLUSION/PHYSICAL RESTRAINT/EMERGENCY USE OF MEDICATION PHYSICIAN ORDER FORM" documented a telephone order was received from the physician on 8/08/13 at 6:00 PM, for the use of physical restraint and Haldol Decanoate 50 mg IM. The physician authenticated the order on 8/12/13, untimed.

The DON reviewed the record and was interviewed on 10/16/13 beginning at 1:35 PM. She confirmed the physician had not authenticated the orders within 24 hours in accordance with medical staff rules.

Verbal orders for restraint or seclusion were not authenticated.