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TWO RIVERS BEHAVIORAL HEALTH SYSTEM 5121 RAYTOWN ROAD KANSAS CITY, MO Oct. 19, 2011
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0168
Based on interview, record review and policy review, the facility failed to ensure that physicians authenticated all orders for restraints/seclusion. This practice affected two (#22 and #26) of five discharged patients reviewed for restraints. The facility census was 44.

Findings included:

1. Record review of the facility's policy titled "Restraints; Seclusion; Protective Holds," Section A, dated 01/17/11 showed the following:
-Physician orders, consultation, and evaluation: Restraint/seclusion is used only in an emergency and requires a physician's order.
-The physician shall authenticate the telephone/verbal order within 24 hours.

2. During an interview on 10/19/11 at 2:40 PM Staff B, Registered Nurse (RN), Director of Nursing (DON), stated that obtaining physician signatures on restraint orders is a problem.

3. Review of Patient #22's medical record on 10/19/11 at 2:00 PM, showed a restraint order for a protective hold on 08/17/11 at 10:20 AM and on 08/17/11 at 2:35 PM. Restraint orders dated 08/18/11 at 9:15 AM showed orders for a protective hold and seclusion. Restraint orders dated 08/18/11 at 3:14 PM showed an order for seclusion. There was no physician's signature, date or time on the orders noted above.

4. Review of Patient #26's medical record on 10/19/11 at 2:00 PM showed a restraint order dated 10/4/11 at 2:20 PM for a protective hold. The physician signed and dated the form, but did not include a time for his/her signature.