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MEMORIAL MISSION HOSPITAL AND ASHEVILLE SURGERY CE 509 BILTMORE AVE ASHEVILLE, NC 28801 June 6, 2019
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0168
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on hospital policy review, medical record review and staff interview, the hospital staff failed to obtain a physician order for a violent restraint for 1 of 2 violent restraint patient records reviewed (Patient #9).

The findings included:

Review on 06/05/2019 of a policy titled "Restraint Use - Violent" last revised 06/2017 revealed "...3. Orders a. When alternative methods are unsuccessful in managing violent behavior, an order for restraint, seclusion and/or therapeutic hold should be obtained from the LIP (licensed independent practitioner)..."

Closed medical record review of Patient #9 on 06/05/2019 revealed a [AGE] year old female who arrived to the emergency department (ED) via law enforcement involuntarily committed for violent behavior and self-harm. Review of the violent restraint flowsheet documentation dated 04/26/2019 at 2201 revealed Patient #9 was placed in a therapeutic hold for 13 minutes due to violent behaviors towards staff members after restraint alternatives were attempted. Review revealed on 04/26/2019 at 2216 Patient #9 was placed in a therapeutic hold for 5 minutes and bilateral ankle and wrists restraints for harm to self and others after restraint alternatives were attempted. Review revealed an order for bilateral ankle and wrists restraints on 04/26/2019 at 2225. Review of the physician orders failed to reveal an order for both therapeutic holds. Review revealed Patient #9 was transferred to an inpatient psychiatric facility on 05/14/2019.

Interview on 06/06/2019 at 1100 with the ED Medical Director revealed MD #1 (Medical Doctor) was not available. Interview revealed physicians are the only providers who can put in an order for restraints. Interview revealed physicians can give a verbal order for restraints but if the patient was having a crisis, the ED physician would go to the patient's bedside.

Interview on 06/05/2019 at 1510 with RN #1 (Registered Nurse) revealed Patient #9 was in the behavioral health holding area (BHU) when she was restrained. Interview revealed if staff had to restrain a patient the RN normally would call the emergency department physician to get a verbal order or the physician would come over to the BHU. Interview revealed nurses did have to get an order for a therapeutic hold and RN #1 did not know why Patient #9 did not have an order for the two therapeutic holds on 04/26/2019.

Interview on 06/05/2019 at 1530 with Nurse Manager #1 revealed there was no available documentation in the record for Patient #9 of a physician's order for both restraints. Interview confirmed the findings.

NC 417, NC 875