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TRMC cited for restraining practices

Updated:

TULSA, Okla. (AP) _ A Tulsa hospital could risk loss of federal funding if it doesn't address concerns listed in a citation it received after a restrained man died.

The Oklahoma Department of Health cited Tulsa Regional Hospital after a two-day inspection last month. The citation stems from a complaint by the family of a 63-year-old man who nurses hadn't checked on for more than three hours before finding him dead.

During the Nov. 18-19 visit, inspectors found that the hospital failed to follow federal regulations and hospital policy on restraints for six out of six patients whose charts were reviewed.

Restraining vests, wrist and ankle restraints, and four raised bed rails, must be ordered by a physician. If restraints are used for behavioral purposes with combative patients, nurses must monitor the patient every 15 minutes.

Cases in which restraints are used for medical reasons require nurses to monitor the patient every two hours.

According to a Nov. 22 report, nurses had not checked on the 63-year-old man for more than three hours before finding him dead.

Dr. Dan Fieker, the hospital's chief medical officer, said certain apsects of documentation could be improved.

``However, the care was appropriate,'' Fieker said.

Nurses checked on the patient, but they wrote a narrative record instead of using the proper forms, said Delores Copp, chief nursing officer.

The report states that the man was admitted to the hospital Aug. 7 from a boarding home after he fell and fractured his hip. The unnamed patient had a history of dementia and schizophrenia, but his medical condition was described as stable.

He remained at the hospital after his hip surgery because the boarding home lacked rehabilitation facilities.

The patient was frequently placed in restraints because of his combativeness, but the restraints were not always ordered by doctors, the report states.

Fieker explained that the restraints were not for behavioral problems because the patient was not violent toward others. That meant he would be checked every two hours, not every 15 minutes.

At one point the report describes the patient as ``very combative with both hands in fist and swinging at people.''

He was put in restraints and was seen thrashing around in his bed, according to Aug. 10 nursing reports stated in the inspection record. When he fell out of a chair the day before his Aug. 15 death, a doctor approved the use of a vest restraint, the report states.

At midnight, the nursing records stated, the man was ``awake, alert'' and wearing the vest.

``The nurse then noted ... `03:10 pt (patient) found to be unresponsive, cool to touch, no respirations ... pupils fixed and dilated. ...' The registered nurse failed to assess the restrained patient from 12:00 midnight until 03:10 a.m.,'' the report states.

When a team arrived to resuscitate the patient, the resident in charge declined to begin CPR because of the man's appearance and pronounced him dead at 3:25 a.m., the report states.

``According to the post-mortem checklist, the nurse noted the patient's death as meeting criteria for Medical Examiner Notification; however, the nurse noted the medical examiner was NOT notified,'' the report states.

Officials with the state Medical Examiner's Office said they were unaware of the case. The hospital listed the cause of death as ``sudden cardiac arrest.''

Federal officials gave the hospital 23 days to correct the concerns or risk losing Medicare and Medicaid certification.
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