HospitalInspections.org

Based on records review and interviews, the facility failed to ensure that physician orders were in place for restraints to be applied to patients. 10 of 10 (#1-10) patients were restrained without a current physician's order.

Findings include:

Review of facility policy OPS-010, "Use of Restraints in Rehabilitation Hospitals," revealed the following:

"Restraint is the direct application of physical force to a patient, with or without the patient's permission, to restrict his or her freedom of movement. The physical force may be any human, manual method, physical or, mechanical device, material, equipment or a combination thereof that immobilizes or reduces the ability of a patient to move his or her arms, legs, body or head freely. Restraint has the potential to produce serious consequences, such as physical or psychological harm, loss of dignity, violation of individual's rights, and even death."

AND

"Side rails used to restrict the patient's freedom to exit the bed are considered a restraint."

AND

Under the section, "Order/Renewal," restraint usage "Requires LIP (licensed independent practitioner) reorder every calendar day."


Review of patient records revealed the following patients in restraints without a current physician's order:

#1- Per nursing documentation, the patient was in restraints (side rails up x4) on 5/18/13 and 5/19/13 with no current physician's order;

#2- Per nursing documentation, the patient was in restraints on 10/13/13 (bed enclosure) and 10/14/13 (bed enclosure and side rails up x4) with no current physician's order;

#3- Per nursing documentation, the patient was in restraints (side rails up x4) on 10/18/13 and 10/20/13 with no current physician's order;

#4- Per nursing documentation, the patient was in restraints on 9/05/13 (lap restraint), 9/13/13 (bed enclosure), and 9/23/13 (lap restraint) with no current physician's order;

#5- Per nursing documentation, the patient was in restraints (side rails up x4) on 9/13/13 and 9/17/13 with no current physician's order;

#6- Per nursing documentation, the patient was in restraints (lap restraint) on 9/07/13 with no current physician's order;

#7- Per nursing documentation, the patient was in restraints (lap restraint) on 9/02/13 with no current physician's order;

#8- Per nursing documentation, the patient was in restraints (side rails up x4) on 9/18/13 and 9/23/13 with no current physician's order;

#9- Per nursing documentation, the patient was in restraints on 9/17/13 (bed enclosure) and 9/24/13 (side rails up x4) with no current physician's order;

#10- Per nursing documentation, the patient was in restraints on 9/13/13 (side rails up x4), 9/16/13 (side rails up x4), and 9/23/13 (lap restraint) with no current physician's order.

During an interview on 10/22/13 at 1:15pm, staff #3 reviewed the charts and confirmed these findings.