HospitalInspections.org

Based on review of documents and interview of staff members, it was determined the facility failed to attempt less restrictive interventions before placing a patient in a therapeutic hold or in restraints, per policy, for one (1) of one (1) restraint records reviewed (Patient # 8). This infringes on the rights of all patients to be free of restraints/seclusion except in cases where an immediate threat to self or others is demonstrated.

Findings include:

1. The facility policy entitled "Seclusion and Restraint", last reviewed 1/2/15, was reviewed on 3/29/16. It states, in part, "Least restrictive control measures should be used to manage the patient requiring behavior management. These measures include, but are not limited to: 1. Discussing therapeutic approach with charge nurse", and lists eight (8) more alternative interventions. It further states, in part, "The use of restraint or seclusion will be used only after assessment and when less restrictive measures have failed."

2. Patient # 8's medical record was reviewed on 3/29/16. The document entitled "Hold/Seclusion/Restraint Safety Flow Sheet Record" (Restraint Sheet) dated 1/1/16 revealed the patient had been placed in a therapeutic hold at 10:10 a.m. Review of Day Shift Nursing Notes for this date revealed the entry "0930-Patient very agitated and upset over argument with another patient. In hallway acting out and screaming. Acting out for attention. 10:10am-Pt put in hold because of acting out toward staff. Held for 5 mins." No documentation was found demonstrating an immediate threat of harm to the patient or others, or of alternate interventions attempted by nursing staff prior to the hold.

3. Further review of Patient # 8's record included two (2) Restraint Sheets dated 1/2/16; the first for 8:50 a.m., the second for 2:20 p.m., both revealing therapeutic hold and mechanical restraints employed. Review of Day Shift Nursing Notes revealed the entry "850-pt irate with staff-put in hold for 30 mins and given IM (intramuscular injection)thorazine. 1420-Pt irate again with staff striking BHT (Nurse's Aide)-pt in hold for 30 mins and given...(medication by mouth). 1455-Pt let out of hold and started striking staff again. Put in seclusion in 4 point restraint for up to an hour. Pt let out of restraint at 1550 and resting". No documentation was found
demonstrating an immediate threat of harm to the patient or others, or of alternative interventions attempted by nursing staff prior to the hold and/or mechanical restraints used.

4. Further review of Patient # 8's record included a Restraint Sheet dated 1/3/16 revealing the patient was placed in mechanical restraints at 4:00 p.m. and released after one (1) hour. Review of Day Shift Nursing notes revealed the entry "15:45 became oppositional and tore up paperwork for group, was kicking BHT under the table." Further patient behaviors were documented, and then the entry "A hold was initiated and she was placed in the seclusion room in 4 point restraints." No documentation was found of an immediate threat of harm to the patient or others, or of alternative interventions attempted by nursing staff prior to the use of restraints.

5. The above documentation was reviewed with the Chief Nursing Executive on 3/30/16 at 12:30 p.m. at which time she concurred with these findings.