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Based on medical record review, staff interview, and review of the facility policy, the facility failed to ensure the least restrictive type or technique of restraint was used to protect the patient or others from harm (A0165).

Based on medical record review, staff interview, and review of the facility policy, the facility failed to ensure the least restrictive type or technique of restraint was used to protect the patient or others from harm for one (Patient #1) of 10 patients reviewed. This had the potential to affect the facility's 157 patients.

Findings include:

Review of the medical record revealed Patient #1 presented to the facility on 05/09/21 at 12:43 AM with a chief complaint of mental disorder. The disposition diagnoses listed as: noncompliance with medication regimen, paranoid schizophrenia, and rhabdomyolysis. Patient #1 was intubated on 05/09/21 at 5:51 AM.

The physician note written by Staff N on 05/09/21 at 6:05 AM documented "Still very much not re-directable and painted into a corner and given the risk to staff upstairs, made the decision to electively intubate for staff protection."

The first order for restraints in the medical record was on 05/09/21 at 7:11 AM. The order was for right wrist/ left wrist soft restraints.

A psychiatric consultation note written by Staff O on 05/10/21 at 1:32 PM documented patient originally came to the emergency department for leg pain, left against medical advice and then returned with command auditory hallucination to kill himself. While here, patient became aggressive with staff. It is unclear if patient assaulted any staff or threatened staff, however patient was given Ketamine, Ativan and Geodon intramuscular at that time. Patient's agitation worsened and patient was sedated and intubated "for staff safety."

A behavioral health progress note written by Staff Q on 05/11/21 at 12:07 AM documented the patient was given Ativan and Geodon, was still not redirectable, and was electively intubated for "staff safety."

On 05/11/21 at 1:00 AM, an order was placed for locked restraints, used for violent/destructive patients only.

Interview on 06/24/21 at 10:09 AM., Staff A reported restraints were first placed on Patient #1 on 05/09/21 at 7:10 AM.

Review of the facility policy titled "Patient's Rights and Responsibilities" (P-10-1, Revised 12/07) revealed under Guidelines: A. All patients/significant others can be assured that their rights concerning the below are provided for: Freedom from the use of seclusion or restraint of any form as a means of coercion, convenience or retaliation by staff. 9. The patient has the right to be free from the use of restraint or seclusion of any form as a means of coercion, convenience or retaliation by the facility's staff. Use of restraint for medical/surgical patients will only occur when the use of the restraint is the least restrictive way to protect the patient's safety, or that of others. There may be occasions for medical/surgical patients in which the use of restraint is necessary to ensure the delivery of essential care, such as IV medication, where the omission of such treatment would be severely detrimental to the patient. In behavioral health (psychiatric) settings, the use of restraint and seclusion will be an emergency measure reserved for unanticipated severely aggressive or destructive behavior, which places the patient or others in imminent danger.

Review of the facility policy titled "Restraint Use: Violent or Destructive Patient Behavior" (R-16-2, Revised 10/2017) revealed under Purpose/Philosophy: The purpose of this policy is to provide guidelines for the safe and appropriate use of restraints for violent or destructive behavior such as harm to self or others, agitation/assaultive behavior and/or combativeness; To reduce the risk of injury to patients and staff; and To comply with all current laws, regulations and accreditation agencies related to the use of restraints. The policy revealed Under Standard of Care: ·All patients have the right to be free from restraints that are not medically necessary or are used for purposes other than patient benefit and safety. Restraint or seclusion for any other purpose (i.e. coercion, discipline, or convenience) is not permitted. All patients will have an assessment performed to determine the safety and protective needs of the patient prior to application of restraints. The use of restraints or seclusion is not based on a patient's restraint or seclusion history. Restraints shall be used only where alternative methods are not sufficient to protect the patients or others from injury, and are not a substitute for less restrictive protective measures. Physical Restraint is defined as the use of a physical, or mechanical, or manual device that immobilizes or reduces the ability of a patient to move his/her arms, legs, body or head freely or the patient's freedom of movement, physical activity, or normal
access to his/her body to protect him/herself or others from injury. The policy documented Under Section C. Restraint Initiation: 3. Acceptable Types of Restraints include, but are not limited to: vest, cloth limb, or mittens with ties. Restraints will be applied in accordance with manufacturer's recommendations. 8. Restraints shall be implemented in the least restrictive manner possible.

This deficiency substantiates Substantial Allegation OH00122499.