HospitalInspections.org

Based on a review of patient #7 (P7) record, it was revealed that staff applied a mask to restrained P7 which did not meet criterion for safe care.

Patient #7 (P7) was an adult who presented to the emergency department (ED) in July 2018 on emergency petition. At 1730, P7 was restrained in 4-point restraint due to attempts to hit staff. Flow documentation for the next 4 hours from 1730 to 2115 revealed every 15-minute documentation which redundantly documented that P7 was trying to bite and spit. No nursing documentation addressed the interventions regarding these behaviors

A social work note of 2220 noted in part, ":..The pt had a mask over his mouth to prevent him from spitting ..." This meant that staff placed a mask over P7's mouth which due to restraint P7 was unable to remove. Further, staff could not observe P7's mouth for possible sources of aspiration such as vomitus which created an unsafe restraint process for P7.

Based on a review of 10 medical records, it was determined that one patient, patient #7 (P7) was not released from violent restraints at the earliest possible time.

Patient #7 (P7) was an adult who presented to the emergency department (ED) in July 2018 on emergency petition. At 1730, P7 was restrained in 4-point restraint due to attempts to hit staff. Flow documentation for the next 4 hours from 1730 to 2115 revealed every 15-minute documentation which redundantly documented that P7 was trying to bite and spit. No other behaviors and no variations in intensity of behaviors were documented.

A social worker also noted at 2221, " ...As this writer spoke to the pt, he was calm and cooperative while in 4 point restraints. Shortly upon the conclusion of the assessment, the pt was put in 2 point restraints instead of 4 ..."
Documentation revealed that P7, who was documented at 2115 as biting and spitting, was "down-graded" to 2-point restraint at 2122, at the same time the social worker had noted that P7 was "calm and cooperative." Based on the social worker note, nursing documentation failed to give an accurate account of P7's behavior which was the only determinant of whether P7 could be released from restraint

An RN note of 2122 stated, "4pt to 2pt restraints r/t (related/to) improved cooperation. Pt continues to pull at restraints. Pt easily agitated pt given verbal contract if pt remains cooperative restraint will be removed" Based on this documentation, the RN kept P7 in restraint due to "pulling on restraints" which is not criterion for continued restraint; and further conditioned P7's release after P7 had met criterion by ceasing violent and destructive behavior. The RN then delayed release by "down-grading" P7 to 2-points which did not meet regulatory requirements for release at the earliest possible time. P7 was not released for another hour, at 2225.