HospitalInspections.org

Based on record review and interview, the facility failed to ensure that restraint orders were renewed for pediatric patients in behavioral restraints (a device that restricts movement due to violent behavior) for 1 (P (patient) 10) of 3 (P10, P11, and P12) patients reviewed for self-inflicted harm. This deficient practice could possibly result in pediatric patients not being released from behavioral restraints in a timely manner.

The findings are:

A. Record review of the facility's "Restraint Policy" dated 01/07/2025, Under 1.1 "Patients Rights" stated "1.1.2. Staff will monitor and meet the patients' needs while in restraints. 1.1.3. Staff will reassess and encourage release from restraints." Under 2.7 stated "Physical/Mechanical or medical restraint or Seclusion for patients with violent and/or self-destructive symptom that jeopardizes the immediate physical safety of the patient, staff or others" "2.7.1 Orders: . . . 2.7.1.3. Orders are time limited as follows: . . . 2.7.1.3.2. One (1) hour for children under 17 years of age and below."

B. Record review of P10's electronic medical record revealed the following:
1. On 09/30/2024, a soft restraints (fabric and velcro placed on wrists and ankles to limit movement) order was placed at 10:33 PM for violent behavior. The order stated "order must be renewed q1h [every hour] for children eight (8) years of age and younger." The order was discontinued on 10/08/2024 at 12:16 PM.
2. The Flowsheet titled "restraint information" dated 09/30/2024 at 10:35 PM revealed P10 was placed in four-point soft restraints (restraints that limit all arms and legs). Refer to tag A0175.
3. P10, a child under the age of nine (9) years old, the record did not have any evidence that the order was renewed every hour while restrained on 09/30/2024.

C. During an interview with Staff (S) 5, clinical, on 01/16/2025 at 3:47 PM, S5 confirmed P10's soft restraint orders should have been renewed.

Based on record review and interview, the facility failed to ensure that staff monitor pediatric patients in behavioral restraints (a device that restricts movement) for 1 (P (patient) 10) of 3 (P10, P11, and P12) patients reviewed for self-inflicted harm. This deficient practice could possibly result in pediatric patients not getting their basic needs met while restrained such as bathroom, hydration, and other required assessments.

The findings are:

A. Record review of the facility's "Restraint Policy" dated 01/07/2025, Under "1.1 "Patients Rights" stated "1.1.2. Staff will monitor and meet the patients' needs while in restraints. 1.1.3. Staff will reassess and encourage release from restraints." Under 2.7.1 stated "2.7.7.5.3. Q 5 [every 5] minutes documentation of the following for children < [less than] 18 years old. 2.7.7.5.3.1. Rationale for continuation of restraint. 2.7.7.5.3.2. Evaluation of status in restraints."

B. Record review of P10's electronic medical record revealed the following:
-On 09/30/2024, a soft restraint (fabric and velcro placed on wrists and ankles to limit movement) order was placed at 10:33 PM for violent behavior. The order stated, "order must be renewed q1h [every hour] for children eight (8) years of age and younger." The order was discontinued on 10/08/2024 at 12:16 PM.
-The Flowsheet titled "restraint information" dated 09/30/2024 at 10:35 PM revealed 10 was placed in four-point soft restraints (restraints that limit all arms and legs); under "restraint skin assessment" stated, "Pulses intact, skin intact." The flowsheet did not contain any restraint documentation or restraint assessments for restraint monitoring from 09/30/2024 through 10/08/2024.
-On 10/15/2024 at 6:26 AM, a soft restraints order was placed for violent behavior. The order was discontinued at 11/10/2024 at 5:20 PM.
-On 10/18/2024 at 8:50A M, Provider note stated "While admitted she (P10) has had a couple of episodes of agitation . . .and required to be put in soft restraints 2X [times]"
-The flowsheet titled "Restraint information," dated 10/15/2024 collected at 6:00 AM revealed the flowsheet did not contain any evidence that a skin assessment was performed. The flowsheet did not contain any restraint documentation or restraint assessments for restraint monitoring from 10/25/2024 to 11/10/2024.

C. During an interview with Staff (S) 5, clinical, on 01/16/2025 at 3:47 PM, S5 confirmed that every 15-minute monitoring was not documented for P10. S5 explained that staff should be monitoring the patient in restraints per policy.