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ST CLARE HOSPITAL
PATIENT RIGHTS: RESTRAINT OR SECLUSION
Tag No.: A0165
Based on interview and document review, the hospital failed to attempt to use the least restrictive restraint measures for a patient that required the use of restraints for violent and self-destructive behavior for 1 of 3 patient records reviewed (Patient #1).
Failure to attempt the use of a least restrictive restraint put patients at risk for emotional distress.
Findings included:
1. The hospital policy titled "Restraint and Seclusion Policy, 964.00," revised 12/2018, showed that use of restraints was to be limited to the use of the least restrictive measures to keep patients safe from harming them self or others.
2. Review of Patient #1's medical record showed the patient was brought to the hospital after harming their caregivers in their community care setting. The patient was assessed by the county mental health professional and put on a 90 day hold. While in the hospital the patient remained in 4 point restraints except for bathing, eating, and range of motion for extremities. The patient was taken out of restraints while their family visited as the patient would respond to their family but would become agitated when their family left. The patient was kept in restraints for walks in the hallway due to the patient previously assaulting a patient when the restraints were removed.
The patient was assessed every 4 hours for the continued use of restraints. It was documented in the assessment the patient remained "aggressive". There were no interventions documented that were tried to help reduce the patient's aggressive behavior and remove the 4 point restraints. The patient was in 4 point restraints for 61 days until they were discharged to a mental health hospital.
3. On 02/07/19 between 11:30 AM and 12:45 PM, Staff #1, #2, #3, #4, #5 and #6, registered nurses, were interviewed separately. The staff stated that attempts to reduce the use of 4 point restraints should be attempted and documented.
4. On 02/07/19 at 2:30 PM, the Chief Nursing Officer, (Staff #7) was interviewed and verified the above findings.