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Based on observation, interview, and record review the General Acute Care Hospital (GACH) failed to ensure physician orders for physical restraints were renewed per the facility policy for 1 of 30 sampled patients (Patient 25).

This failure had the potential to result in the unnecessary use of physical restraints.

Findings:

During a concurrent observation/interview on 1/18/18 at 9:30 a.m., with Registered Nurse (RN) 1 and the Director of Critical Care (DCC), it was noted that Patient 25 had bilateral (both sides) soft wrist restraints in place.

During a concurrent interview/record review with RN1 and DCC on 1/18/18 at 9:50 a.m., a physician order dated 1/14/18 at 1600 (4 p.m.) for restraint use was noted in the Electronic Health Record (EHR). The subsequent order renewal was noted in the EHR dated 1/18/18 at 0900 (9 a.m.). The DCC and RN1 verified the order renewal exceeded 72 hours (3 days). RN1 verified that the physician order was not renewed per the facility policy.

Review of the facility policy titled Restraints for Management of Nonviolent / Nonself-destructive Behaviors dated September 2014 indicated the following: "A physician order is required for the application of restraint(s) ...If a patient remains in restraint for more the (3) consecutive calendar days then a new order must be obtained ..."

Based on observation, interview, and record review the General Acute Care Hospital (GACH) failed to ensure 1 of 30 sampled patients (Patient 25) was monitored in accordance with hospital policy during the use of physical restraints.

This failure had the potential to result in physical injury to Patient 25.

Findings:

During a concurrent observation/interview with Registered Nurse (RN) 1 and the Director of Critical Care (DCC) on 1/18/18 at 9:30 a.m., it was noted that Patient 25 had bilateral (both sides) soft wrist restraints in place.

During a concurrent interview and clinical record review with RN 1 on 1/18/18 at 9:50 a.m., the Electronic Restraint Flowsheet was reviewed. RN 1 verified that there was no documented evidence of the monitoring of Patient 25's restraints in the record from 1/16/18 at 2200 (10 p.m.) to 1/17/18 at 0800 (8 a.m.). RN1 stated that patients in restraints should be monitored and the assessment should be documented every two hours.

Review of the facility policy titled Restraints for Management of Nonviolent / Nonself-destructive Behaviors dated September 2014 indicated the following: "Monitoring / Interventions / Reassessment / Education ...Monitoring determines the following: ...The patient's physical and emotional well-being ...Changes in the patient's behavior or clinical condition needed to initiate removal of restraints ...The above including psychological status and comfort shall be assessed at least every two hours ...Nursing interventions are provided as needed and minimally, every two hours. Which include but are not limited to: ...Evaluation of circulation, skin integrity, including skin friction points and ROM (Range of motion) ...Turn and reposition patient if patient unable to do so ..."