HospitalInspections.org

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Based on record review, interview, and review of hospital policy and procedures, the hospital failed to ensure that patients do not receive chemical restraints, as directed by hospital policy in 3 of 4 patients (Patient #901, #902, and #903)

Failure to ensure that staff follow approved policies and procedures for restraint use risks severe physical and psychological harm, loss of dignity, and is a violation of patient rights.

Findings included:

1. Document review of the hospital's policy and procedure titled, "Restraint and Seclusion Policy, 964.00," PolicyStat ID #12719679, last approved 12/22, showed the following:

a. A restraint is any physical or chemical method, mechanical device, or equipment that immobilizes or reduces a patient's ability to move or access any body part.

b. The hospital uses the least restrictive form of restraint or seclusion to protect the physical safety of the patient, staff, or others.

c. The hospital does not use restraints or seclusion as a means of coercion, discipline, convenience, or staff retaliation.

d. Chemical restraint is not a standard use of medication to treat a patient's medical or behavioral condition. Virginia Mason Franciscan Health (VMFH) does not use chemical restraint.

2. On 06/18/24 between 10:00 AM and 12:00 PM, Investigator #9 and Chief Nursing Officer (Staff #901) reviewed the medical records of patients who had been restrained. The review showed the following:

a. On 06/15/24 at 8:34 PM, Patient #901 was brought into the Emergency Department for a mental health evaluation. At 8:36 PM, orders were placed by a provider for violent restraints and Droperidol (an antipsychotic medication) 2.5 milligrams intramuscularly, Midazolam (a sedative hypnotic medication) 2 milligrams intramuscularly (IM), and Diphenhydramine (an antihistamine and sedative) 50 mg intramuscularly. The investigator found no documentation of the application of physical restraint. At 9:00 PM, the patient's behavior was documented as cooperative and anxious. At 9:09 PM, the patient's behavior was documented as resting/asleep. At 9:15 PM, the patient's behavior is documented as resting/asleep. At 9:15 PM, the patient received Droperidol 2.5 milligrams IM and Diphenhydramine 50 milligrams IM. At 9:16 PM, the patient received Midazolam 2 milligrams IM. At 9:43 PM, the provider documentation showed that the patient was taken out of violent restraint and was sleepy but arousable.

b. On 06/13/24 at 7:05 PM, Patient #902 was brought into the Emergency Department for evaluation for possible drug intoxication. At 7:07 PM, the patient was placed in violent 4 point locking restraint with a chest strap. At 7:21 PM, orders were placed for Droperidol 5 milligrams injection, Midazolam 2 milligrams intramuscularly, and Diphenhydramine 50 mg intramuscularly. At 7:31 PM, the patient received Diphenhydramine 50 mg intramuscularly and Midazolam 2 milligrams intravenously. At 7:37 PM, the patient received Droperidol 5 milligrams intravenously.

c. On 06/11/24 at 8:32 PM, Patient #903 was brought into the Emergency Department by a friend for evaluation for inability to care for himself. At 9:45 PM, the patient became agitated and yelling at staff and was placed in violent locking 4 point restraint. The patient's psychological status is documented as agitated/restless, tearful, delusional, and confused. At 9:57 PM, Droperidol 2.5 milligrams intramuscularly and Lorazepam (an antianxiety medication) 2 milligrams was administered. Provider documentation on 06/12/24 at 12:50 PM, showed that the patient is too sedated to perform mental health evaluation at this time.

3. At the time of the review, Staff #901 verified the documentation of restraint as above. Investigator #9 interviewed Staff #901 regarding what the hospital considered to be a chemical restraint. Staff #901 stated that the hospital does not use chemical restraints.
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