HospitalInspections.org

Based on interview, record review and policy review, the hospital failed to obtain a physician's order for the initial applications of medical-surgical restraint (any manual method, physical or mechanical device that limits the ability of free movement of arms, legs, body or head) for one current patient (#6) of four restraint patients reviewed. The hospital failed to renew a restraint order in a timely manner for one current patient (#6) of four restraint patients reviewed. This failure created an unsafe environment and had the potential to place all patients admitted to the hospital at risk for their safety.

Findings Included:

Review of the hospital's policy titled, "Restraint and Seclusion," dated 01/2023, showed the Registered Nurse (RN) will notify the patient's physician of restraint initiation either during the application or immediately following restraint application and obtain a valid written/telephone order. A new restraint order must be completed and reviewed as part of the weekly Interdisciplinary Team Process.

Review of the "Nursing Assessment Flow Sheet," dated 09/15/23, showed Patient #6 was placed in medical-surgical restraints on 09/15/23 at 12:41 PM. The initial medical-surgical restraint order was written on 09/15/23 at 9:47 PM. Patient #6 was in medical-surgical restraints without a current order for nine hours and six minutes.

Review of Patient #6's medical record, showed Patient #6's order for medical-surgical restraints expired on 09/22/23 at 9:47 PM and was not renewed until 09/23/23 at 2:48 PM. Patient #6 remained in medical-surgical restraints for 17 hours and one minute without a current restraint order.

During an interview on 09/28/23 at 9:30 AM, Staff B, Nurse Manager, stated that the nurses would contact the provider when restraints were needed to obtain the order. Restraint orders required renewal every seven days. Both nurses and providers were responsible to ensure restraint orders were renewed every seven days when continued restraint use was needed beyond the seven days.

Based on interview, record review and policy review, the hospital failed to ensure appropriate monitoring and nursing documentation during the use of restraints (any manual method, physical or mechanical device that limits the ability of free movement of arms, legs, body or head) for two current patients (#2 and #6) and one discharged patient (#25) of four restraint patients reviewed. This failure created an unsafe environment and had the potential to place all patients admitted to the hospital at risk for their safety.

Findings Included:

Review of the hospitals policy titled, "Restraint and Seclusion," dated 01/2023, showed that the use of restraints requires observations, assessments and care completed as often as needed but at least every two hours for medical-surgical restraints.

Review of Patient #2's restraint documentation showed:
- Her restraints were assessed on 09/17/23 at 1:31 PM, with her next assessment documented at 11:44 PM, 11 hours and 13 minutes later.
- Her restraints were assessed on 09/17/23 at 6:04 AM, with her next assessment documented at 1:31 PM, seven hours and 37 minutes later.
- Her restraints were assessed on 09/15/23 at 1:04 PM, with her next assessment documented at 8:57 PM, seven hours and 53 minutes later.

Review of Patient #6's restraint documentation showed her restraints were assessed on 09/24/23 at 8:00 PM. Her next restraint assessment was documented on 09/25/23 at 7:48 AM, 11 hours and 48 minutes later. Her restraints were assessed on 09/26/23 at 3:21 AM. Her next restraint assessment was documented at 7:16 AM, three hours and 55 minutes later.

Review of Patient #25's restraint documentation showed:
- Her restraints were assessed on 09/13/23 at 10:08 AM, with her next assessment documented at 2:20 PM, four hours and 12 minutes later.
- Her restraints were assessed on 09/13/23 at 2:20 PM, with her next assessment documented at 5:44 PM, three hours and 24 minutes later.
- Her restraints were assessed on 09/13/23 at 7:15 PM, with her next assessment documented at 9:57 PM, two hours and 32 minutes later.
- The last documented restraint assessment was completed on 09/13/23 at 11:56 PM. Patient #25 was transferred to another hospital on 09/14/23 at 10:48 AM, 10 hours and 52 minutes after the last documented assessment.

During an interview on 09/28/23 at 9:30 AM, Staff B, Nurse Manager, stated that she expected staff to assess every patient in restraints and document their assessment in the patient's medical record every two hours.