UPMC Mercy Cited in Deaths

By Walter F. Roche Jr.

A Pittsburgh hospital has been cited by state regulators for misuse of patient restraints including four cases where patients died within 24-hours of being in restraints.
In a detailed report recently posted by the state Health Department, UPMC Mercy was cited for placing patients in restraints without a doctor's orders, failing to release patients from restraints as soon as possible and failing to report to federal officials that patients who died had been in restraints within 24 hours of their deaths.
The report is only the latest of several to detail violations of restraint requirements in Pennsylvania hospitals.
Officials of the 404-bed acute care hospital filed a plan of correction in response to the report in which they disclosed a number of steps being taken to correct the problems. The plan includes a re-education program for staffers on the limitations for restraint use and an auditing system to ensure that the corrective actions are being followed.
The hospital also said it would establish a daily mortality list which will be reviewed to ensure that deaths are being properly reported to the state and the U.S. Centers for Medicare and Medicaid Services.
UPMC officials did not respond to requests for comment.
In the state Health Department report surveyors found that four patients, identified only as MR2, MR3, MR4 and MR7, had died either while in restraints or within 24 hours of being released from restraints. Nonetheless the hospital failed to include that information in filings with state and federal health officials.
"Hospitals must reports deaths associated with the use of seclusion or restraint," the report states.
In another finding the surveyors found that, despite a policy forbidding it, physicians had issued standing orders for use of restraints on an as needed basis.
"Orders for the use of restraints must never be written as a standing order," the report states.
Regarding the release of patients from restraints as soon as possible, the inspectors found that one patient was kept in restraints even though the patient was described as "quite calm."
Asked about the finding a hospital staffer told the surveyor," These are newer nurses. It looks like they need further education."
Another deficiency noted in the report was the failure to include in four patients' records the symptoms that warranted the use of restraints, such as side rails.
Yet another deficiency cited was the failure to follow a physician's orders regarding the use of restraints. In one case cited a patient was put in restraints even though the doctor had not ordered it.
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