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Based on record review, policy and procedure review and interviews, the Hospital failed to follow Hospital policy and ensure that alternatives or less restrictive interventions to restraint were attempted and documented for one patient (Patient #1) out of a total sample of 10 patients.

Review of Patient #1's History and Physical, dated 12/16/14, indicated that Patient #1, a 92 year old, was admitted to the Hospital for nausea and vomiting. The History and Physical indicated that Patient #1 had a history of short term memory loss, atrial fibrillation (irregular heartbeat), gastroesophageal reflux disease (stomach acid flows back into the esophagus-the tube connecting the throat to the stomach) and upper gastrointestinal bleed (bleeding in the upper portions of the intestinal tract).

The Hospital Policy titled, Restraint for Non-Violent/Non-Self-Destructive Patient, revised date 3/2013, indicated that the enclosed bed was a restraint because it restricted the environment and physical activity of the patient. The Policy indicated that a drug was a restraint when used to manage the patient's behavior and is not a standard treatment for the patient's condition. The Policy indicated that staff will utilize alternatives prior to resorting to restraints such as reorientation, utilization of bed/chair alarms, or constant observation. The Policy indicated that documentation in the patient's record should indicate a clear progression of how techniques are implemented with less restrictive interventions attempted or determined to be ineffective prior to the introduction of more restrictive measures.

Nursing Notes, dated 12/17/14 at 3:38 A.M. to 12/19/14 at 8:12 P.M. regarding Patient #1's affect and behavior, indicated that Patient #1 had been calm and cooperative and occasionally vague and forgetful.

A Nursing Note, dated 10:00 P.M. on 12/19/14, indicated that Patient #1 was to be transferred from the Telemetry Unit (unit with cardiac monitoring) that he/she was on to a Medical Surgical Unit because of the need for a telemetry bed. The Nursing Note indicated that Patient #1 ambulated from the bed to a wheelchair and then became agitated and confused. The Nursing Note indicated that Patient #1 attempted to leave the unit and Security Personnel were called. The Nursing Note indicated that Patient #1 threw urine at the Security Personnel and remained confused and combative. The Nursing Note indicated that Patient #1 was placed in an enclosed bed (a netted canopy system that fits over a hospital bed on all sides) and given 5 milligrams (mg) of Haldol (an antipsychotic medication used in the treatment of agitation and severe anxiety) intravenously (IV-into the vein). The Nursing Note indicated that the Physician was aware.

The Medication Administration Record indicated that Patient #1 was given Haldol 5mg IV at 10:24 P.M. on 12/19/14.

Restraint Documentation indicated that Patient #1 was placed in the enclosed bed at 10:45 P.M. on 12/19/14.

Restraint Documentation indicated that Patient #1 came out of the enclosed bed at 11:08 A.M. on 12/20/14.

Nursing Notes did not indicate any progression of alternatives to restraint attempted prior to administration of the chemical and physical restraint.

The Surveyor interviewed Physician #1 at 7:25 A.M. on 2/5/15. Physician #1 said that she assessed Patient #1 at the time that he/she had become agitated and combative. Physician #1 said that she ordered the Haldol and enclosed bed.

Review of the Physician Progress Notes did not indicate an assessment of Patient #1 behavior or that any progression of alternatives to restraint were attempted prior to the administration of the chemical and physical restraint.