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Based on a review of restraint records of patient #2 and patient #3, it is revealed that were no physician orders for restraint events during emergency department presentations for 2 patients reviewed.

Patient #2 presented to the hospital emergency department (ED) in early February 2017 due to paranoia following noncompliance with medication. Patient #2 had a history of mental illness.

A physician note of 0420 revealed in part, " ...was in the intake room here in the ED he became agitated and would not remove his clothes and change into his scrub. Patient began to rambling stating that "I am going to rape your kids..." A social worker note of 0423 revealed in part, " ...Upon arrival, the patient was transitioned to the intake room where he was asked to remove his clothing and change into scrubs per protocol. Pt refused to cooperative (sp) ...Patient continued to be uncooperative and disruptive with security, nurses, and Dr.__. A code purple was called and the patient was administered Geodon. Pt. had de-escalated and is currently resting in room ..."

A nursing note of 0427 revealed "Pt arrives as an EP (emergency petition) ...Pt very argumentative and non-cooperative in intake room. Pt believes that police took his ID in order to charge him and refusing to change clothes ...Code purple called at 0406 due to Pt refusing to cooperative (sp). Verbal de-escalation attempted prior to code being called without success."

According to documentation, patient #2 went into 4-point restraints on or about 0431, apparently due to disruption of the milieu in the ED. There was no order for restraint found in the record.

Patient #3 was a young adult who presented to the ED in mid-January 2017 via ambulance following an overdose and was triaged at level 2. The record revealed that patient #3 was noted to hit, kick, and bite security and nursing staff. The patient was placed into 4-point restraints at 1757 and released from restraint at 1819. There was no order for restraints in the record.

Based on review of these records, there were no written physician orders for restraints for two ED patients .

Based on a review of restraint records of patient #2 and patient #3, it was revealed no face to face evaluations exist for restraint events during emergency department presentations.


Patient #2 presented to the hospital emergency department (ED) in early February 2017 due to paranoia following noncompliance with medication. Patient #2 had a history of mental illness. A physician note of 0420 revealed in part, " ...was in the intake room here in the ED he became agitated and would not remove his clothes and change into his scrub. Patient began to rambling stating that "I am going to rape your kids..."


A social worker note of 0423 revealed in part, " ...Upon arrival, the patient was transitioned to the intake room where he was asked to remove his clothing and change into scrubs per protocol. Pt refused to cooperative (sp) ...Patient continued to be uncooperative and disruptive with security, nurses, and Dr.__. A code purple was called and the patient was administered Geodon. Pt. had de-escalated and is currently resting in room ..."


A nursing note of 0427 revealed, "Pt arrives as an EP (emergency petition) ...Pt very argumentative and non-cooperative in intake room. Pt believes that police took his ID in order to charge him and refusing to change clothes ...Code purple called at 0406 due to Pt refusing to cooperative (sp). Verbal ed-escalation attempted prior to code being called without success."



According to documentation, patient #2 went into 4-point restraints on or about 0431, apparently due to disruption of the milieu in the ED. No face to face is found in the record. Within the organization of the hospital database, the restraint face to face is done within the written order. Based in the fact that no order was written, consequently, no face to face was completed as well.


Patient #3 was a young adult female who presented to the ED in mid-January 2017 via ambulance following and overdose and was triaged at level 2. The record revealed that patient #3 was noted to hit, kick and bite security, nursing and staff. She was placed into 4-point restraints at 1757 and released from restraint at 1819. No face to face is found in the record. Within the organization of the hospital database, the restraint face to face is done within the written order. Based in the fact that no order was written, consequently, no face to face was completed as well.


Based on review of these restraint records, the hospital failed to conduct face to face evaluations for restraint events of patients #2 and #3.