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HARLAN ARH HOSPITAL 81 BALL PARK ROAD HARLAN, KY 40831 Oct. 20, 2016
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0168
Based on interviews, record reviews, and review of facility policies it was determined the facility failed to ensure a restraint was ordered by a physician for one (1) of ten (10) sampled patients (Patient #1). On 10/13/16 Patient #1 eloped from the facility and was placed in a physical restraint by the Director of the Behavioral Health Unit after being discovered in the parking lot. However, Patient #1's Physician was not notified immediately after the physical restraint so an order could be obtained in accordance with facility policy.

The findings include:

Review of facility policy titled, "Restraint and Seclusion," dated March 2014, revealed a restraint is any manual method or physical/mechanical device that immobilizes or reduces the ability of a patient to move his/her arms, legs, body, or head freely. A Behavioral Health Restraint is defined as the restriction of patient movement for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient. Continued review of the policy revealed restraints shall be ordered by a physician. The order is to include the date, time, and purpose of the restraint, the type of restraint utilized, the length of time the restraint was in use, the specific behaviors that justified the restraint or the action that presented a danger to the patient or others, and the behavioral criteria for discontinuation of the restraint.

Review of Patient #1's medical record revealed the facility admitted the patient on 10/08/16 with diagnoses that included Post Traumatic Stress Disorder and Opioid Dependence. The facility discharged Patient #1 Against Medical Advice on 10/14/16.

Review of an Incident Report dated 10/13/16 revealed at 6:10 PM Patient #1 eloped from the facility and ran into the facility's parking lot. The Director of Behavioral Health "caught up" to the patient, and placed Patient #1 in a physical restraint to stop the patient from running into the roadway.

Interview with Certified Nursing Assistant (CNA) #1 on 10/20/16 at 2:33 PM revealed she was working on 10/13/16 when Patient #1 eloped from the facility. CNA #1 stated she ran outside after the patient along with the Director of Behavioral Health. CNA #1 stated the Director of Behavioral Health caught up with Patient #1 and placed Patient #1 in a physical restraint while they were in the facility parking lot.

Interview with the Director of Behavioral Health on 10/20/16 at 1:30 PM revealed that he was working on 10/13/16 when Patient #1 eloped. He stated he was on the unit and was informed by staff that Patient #1 "ran" from the facility, and he immediately pursued the patient. The Director of Behavioral Health stated he placed Patient #1 in a physical restraint because he was afraid the patient was going to run into the road. Further interview revealed the Director of Behavioral Health stated he informed nursing and medical staff upon his return to the unit that he had placed Patient #1 in a physical restraint. The Director of Behavioral Health stated he thought the order had been written. However, the Director of Behavioral Health stated he had not been involved in any de-briefing sessions as required by the facility's policy.

Interview with Licensed Practical Nurse (LPN) #1 on 10/20/16 at 12:10 PM and 2:30 PM stated she was working in the facility on 10/13/16 when Patient #1 eloped. LPN #1 stated that upon return to the unit the Director of Behavioral Health did not inform her that he had placed Patient #1 in a physical restraint in the parking lot.

Interview with Advanced Registered Nurse Practitioner (ARNP) #1 on 10/20/16 at 12:45 PM and 1:50 PM and with Physician #1 on 10/20/16 at 3:15 PM revealed they were both in the facility at the time Patient #1 eloped and upon Patient #1's return to the facility. However, ARNP #1 and Physician #1 both stated the Director of Behavioral Health did not inform them that Patient #1 had been placed in a physical restraint nor did any nursing staff contact them to order the physical restraint that was implemented for Patient #1.

Interview with the Administrator on 10/20/16 at 4:00 PM revealed he was unaware that the Director of Behavioral Health had placed Patient #1 in a physical restraint and that the Director had not informed the physician of the restraint. The Administrator stated the Director of Behavioral Health should have known that an order had to be obtained after Patient #1 was placed in the physical restraint.