HospitalInspections.org

Based on interview, record review, and policy review, the hospital failed to ensure that the practioner responsible for the care of the patient authenticated, dated, and signed the restraint (any manual method, physical, or mechanical device that limits the ability of free movement of arms, legs, body, or head) and seclusion (the involuntary confinement of a patient alone in a room or area from which the patient was physically prevented from leaving) orders within 24 hours for two patients (#11 and #12) of seven patients reviewed. This failure had the potential to cause poor nursing care outcomes for all patients placed in restraints.

Findings included:

Review of the hospital's policy titled, "Seclusion/Restraint: Acute and Residential Services," dated 11/30/23, showed the provider will sign the telephone/verbal order within 24 hours.

Review of Patient #12's medical record, showed:
- Patient #12 was placed in a physical restraint on 01/09/24 from 2:59 PM through 3:06 PM for banging their head against the wall and became aggressive to staff by swinging at them.
- A telephone order was obtained on 01/09/24 at 2:59 PM for the physical restraint.
- Review of Patient #12's restraint orders on 01/11/24 at 3:30 PM, showed the physician had not signed the order for the physical restraint on 01/09/24.

Review of Patient #11's medical record, showed:
- Patient #11 was placed in a physical restraint on 01/06/24 from 9:30 AM through 9:31 AM for an attempt to hit staff in the face and would not follow directions.
- A telephone order was obtained on 01/06/23 at 12:50 PM.
- Patient #11 was placed in a physical restraint on 01/08/24 at 5:20 PM through 5:23 PM for physical aggression towards staff.
- Patient #11 was placed in seclusion on 01/08/24 at 5:23 PM through 6:50 PM for physical aggression towards staff.
- A telephone order was obtained for seclusion and a physical restraint on 01/08/24 at 5:45 PM.
- Review of Patient #11's restraint and seclusion orders on 01/11/24 at 3:30 PM, showed the physician had not signed the orders for the physical restraint and seclusion on 01/06/24 or 01/08/24.

During an interview on 01/11/24 at 3:15 PM, Staff A, Chief Nursing Officer (CNO), stated that all verbal and telephone orders for restraints and seclusion must be signed by the physician within 24 hours.