HospitalInspections.org

Based on document review and interview, it was determined that the Hospital failed to ensure that the restraint policy's definition of a restraint included a physical hold, which is a manual method that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely. This could potentially affect any patient at the hospital who requires a physical hold.

Findings include:

1. On 11/02/22, the Hospital's policy titled, "Restraint and Seclusion management Policy" (revised 7/15/2021), was reviewed and included, "... Definitions... Restraint - any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body or head freely..."

2. On 11/02/22 at approximately 2:20 PM, an interview was conducted with the Chief Nursing Officer (E#4). E #4 stated that they (staff) were not sure if a "Hold" was considered a restraint.

Based on document review and interview, it was determined that for 1 of 4 patients' (Pt #1) clinical records reviewed for restraint usage, the Hospital failed to ensure that a physician's order was obtained for the application of restraints/physical hold immediately after the restraint was applied.

Findings include:

1. The Hospital's policy titled, "Restraint and Seclusion Management Policy" (revised 9/19/22) was reviewed and required, "... D. Any manual method, physical or mechanical device... that reduces the ability of a patient to move his or her arms, legs, body, or head freely... B. 1) Every order for violent or self-destructive restraint must be in writing... 3) in the event there is an emergency requiring immediate management of violent... behaviors... restraint may be initiated... The order of an authorized clinician must be obtained either during... or as quickly as possible after the restraint has been applied..."

2. The clinical record for Pt.#1 was reviewed on 11/02/22. Pt.#1 presented to the Hospital via ambulance on 7/24/22 at 1:47 PM, with a chief complaint of Mental Illness. The clinical record included the following:

-ED Provider note, dated 7/25/22 at 2:55 PM, included, " ... (Pt.#1) brought in due to psychotic delusional ideation ... states people are out to get her ... afraid for her life and called the police several times ... has history of psychotic ideation ... Patient is medically clear for transfer to Behavioral Health institution ... Visit Diagnosis: 1) Acute Psychosis."

-Clinical Assessment note (entered by E#1), dated 7/25/22 at 2:04 AM, included, "Pt became more and more agitated and talking loudly about religion. (Name of physician) with orders/Pt. medicated as ordered." The clinical record did not include a physician's order for restraint/physical hold.

3. On 11/3/22 an Incident Report, dated 7/28/22, was reviewed and included, "Incident Report Occurred Date: 7/26/22 at 2:26 AM ... End at 7/26/22 at 3:00 AM ... Type: Staff Assist: Physical Intervention: Responding Officers: (E#2, E#5, and E#6) ... Injured: (name of E#1) Wrist scratched ... Upon arrival patient sitting up in her bed yelling at medical staff stating she refused to be transferred to a mental health facility ... the nurse (E#1) requested medical sedatives be administered but the patient refused to cooperate and continued to act out ... patient was informed on final time that she was going to receive a medical sedative, continued to refuse ... (E#2, E#5, and E#6) held down patient's limbs as the nurse administered medication. During the physical intervention the nurse was scratched on her left wrist ... the nurse refused to press charges. Once the patient was calm, all officers cleared the scene. No further injuries were reported ..."

4. On 11/02/22 at 1:45 PM, an interview was conducted with a Security Officer (E#2). E#2 stated that he assisted in holding (Pt.#1's) left arm while other Security Officers (E#5 and E#6) held the other limbs so that the nurse (E#1) can administer an injection.

5. On 11/02/22 at 2:35 PM, an interview was conducted with the Director of the ED (E#3). E#3 stated that a physician's order is required for any type of restraint, including a physical hold while administering a medication. E#3 confirmed that there was no physician's order in (Pt.#1's) clinical record for the physical hold.

6. On 11/3/22 at 9:17 AM, an interview was conducted with an RN (E#1). E#1 stated that (Pt.#1) required a physical hold, to administer a medication. (Pt.#1) was experiencing a psychotic episode and was becoming agitated and aggressive. The Physician gave an order for medication. (Pt.#1) was yelling at (E#1) to get away from her. E#1 asked for help from security staff to hold patient while the medication was given.