HospitalInspections.org

Based on review of facility documents, medical records (MR), and staff interview (EMP), it was determined the facility failed to ensure less restrictive interventions were determined to be ineffective before administering Lorazepam (chemical restraint) for 1 of 1 medical records reviewed (MR1).

Findings include:

Review on December 4, 2017, of facility policy, "Prevention/Alternatives and Use of Restraints/Protective Devices," dated December 21, 2016 revealed "Philosophy: The patient has the right to be free from restraints of any form that are not absolutely medically or behaviorally necessary. Our approach to restraint will protect the patient's health and safety and maintain the patient's dignity. Purpose: 1. To define the circumstances when restraint use may be considered and implemented. 2. To delineate the differences between restraints, protective devices, adaptive devices as well as medical immobilization. 3. To outline the protocol for use of restraints while maintaining the rights and dignity of the patient. Definitions: Restraint: Includes either a physical restraint or a drug that is being used as a restraint. ...2. A drug or medication is considered a restraint when it is used as a restriction to manage the patient's behavior or restrict the patient's freedom of movement and is not a standard treatment or dosage for the patient's condition. ...Policy: ...3. Restraint may only be used when less restrictive interventions have been determined to be ineffective to protect the patient, a staff member, or others from harm. 4. The type or technique of restraint used must be the least restrictive intervention that will be effective to protect the patient, a staff member, or others from harm. ..."

Review on December 4, 2017, of MR1 revealed the patient was admitted on October 12, 2017 for a subarachnoid hemorrhage. MR1 contained an order for Lorazepam (Ativan) 0.5 milligrams (mg) every four (4) hours, Intravenous (IV) push, as needed (prn) for agitation or anxiety from OTH3 on October 12, 2017 at 19:00. The Patient Status Rounding documentation in MR1 on October 12, 2017, at 18:49 revealed MR1 attempted to climb out of bed multiple times and remove C-collar. MR1 redirected. Calming techniques were tried with MR1.

Review on December 4, 2017, of MR1's medication administration record dated October 12, 2017 revealed Lorazepam was administered at 19:11. Reason for medication was agitation or anxiety.

Review of MR1's medication administration record dated October 14, 2017 revealed Lorazepam was administered at 23:18. Reason for medication was agitation or anxiety.

MR1 did not include documentation on October 14, 2017 prior to administering Lorazepam at 23:18 that less restrictive interventions had been determined to be ineffective in order to protect the patient.

Review of MR1's medication administration record dated October 15, 2017 revealed Lorazepam was administered at 03:25. Reason for medication was agitation or anxiety.

Review of MR1 did not include documentation on October 15, 2017 prior to administering Lorazepam at 03:25 that less restrictive interventions had been determined to be ineffective in order to protect the patient.

Interview on December 4, 2017, at approximately 11:30 AM confirmed no documentation in MR1 that less restrictive interventions had been determined to be ineffective in order to protect the patient prior to administering Lorazepam on October 14, 2017 at 23:18 and October 15, 2017 at 03:25.