HospitalInspections.org

Based on record review and interview, the facility failed to renew a violent restraint order after four hours for 1 (#5) of 3 patients reviewed for restraint and seclusion resulting in the loss of patient rights. Findings include:

Review of the medical record for P-5 revealed he was a 34-year-old male who presented to the Emergency Department (ED) 8/2/2024 for evaluation following an assault on family members and police. During his ED visit, an order was given on 8/2/2024 at 1708 for 4-point violent restraints. The restraints were applied on 8/2/2024 at 1708, the same time the order was given. The restraints were not discontinued until 8/2/2024 at 2228. The total time of restraint was 5 hours and 20 minutes.

On 1/27/2025 at 1605, Staff M was queried as to if there was a renewal order for the restraint to which she stated there was not.

Facility policy titled "Use of Restraint" approved 7/15/2024 states, "Authorized restraint may not continue for more than 4 hours...An order for restraint must continue only for that period of time specified in the order or for up to the following limits, whichever is less: i. 4 hours for adults 18 years of age or older...A physician who orders or reorders restraint shall do so in accordance with sections 740(5) of the act..."

Based on record review and interview, the facility failed to release 1 (#5) of 3 patients reviewed for violent restraints and/or seclusion at the earliest possible time resulting in the loss of patient rights. Findings include:

Review of the medical record for P-5 revealed he was a 34-year-old male who presented to the Emergency Department (ED) 8/2/2024 for evaluation following an assault on family members and police. He had no documented psychiatric history. ED physician notes dated 8/2/2024 revealed the patient was "confused, altered, aggressive...was inconsolable and unable to be verbally de-escalated calmly." P-5 attempted multiple times to "strike staff." As a result, an order was given on 8/2/2024 at 1708 for 4-point violent restraints as the patient was at risk of harming himself and/or others. The restraints were applied on 8/2/2024 at 1708, the same time the order was given. While in restraint, the patient continued to "lash out at staff." Medications were given for anxiety and "to help calm patient down although multiple attempts were administered without success." Physician notes continue to document a limited exam due to the patients behaviors. It was determined a lumbar puncture was needed to rule out meningitis. Sedation was administered on 8/2/2024 at 2121 and P-5 was intubated 2130. Further review of restraint documentation revealed the 4-point violent restraints were not discontinued until 8/2/2024 at 2228.

On 1/27/2025 at 1610, Staff A agreed the 4-point violent restraints should have been released shortly after intubation.

Facility policy titled "Use of Restraint" approved 7/15/2024 states, "Restraint: the use of a physical device to restrict an individual's movement... Restraints may only be used when less restrictive interventions have been determined to be ineffective to protect the patient, a staff member, or others from harm... Restraint must be discontinued at the earliest possible time, regardless of the length of time identified in the order."