HospitalInspections.org

Based on clinical record review, policy review and staff interview it was determined the hospital failed to use less restrictive interventions before placing a patient in four-point (all extremities) leather restraints. This affected 1 of 1 (Patient #3) patient reviewed for restraint usage. The total sample size was 10 and the current hospital census at the time of the survey was 273.

Findings include:

The clinical record review for Patient # 3 was completed on 09/01/10. The patient was admitted to the emergency room on 06/16/10 at 04:55 AM with a diagnosis of psychological evaluation for a current admission for suicidal ideation. Nursing documentation revealed at 05:10 AM the patient was uncooperative, refused to allow any testing to be performed. At 5:40 AM nursing documented the patient's behavior continued to escalate and was more aggressive, speaking loudly. At 06:16 AM nursing documentation revealed the patient continued to yell loudly from the room, refused medications and was aggressive. At 06:30 AM nursing documented leather restraint were applied to all four of the patient's extremities and medications were given as ordered.

Review of the hospital policy entitled, "Restraints, Use of For Behavioral Management Reasons" was completed on 09/01/10. The policy revealed on page R-5 page: 1 of 7, under "Supportive Data: Alternatives to the use of restraints are considered before the implementation of any restraint. Restraint is only used when less restrictive interventions have been determined to be ineffective to protect the patient from harm. The choice of a safe, effective and least restrictive methods is determined by the assessed needs of the patient and the effectiveness of less restrictive interventions previously used on the patient." The clinical record lacked evidence of the use of less restrictive interventions prior to the application of the leather restraints to each of the patient's extremities.


This finding was verified during interview with Staff B and C on 09/01/10 at 11:40 AM and with Staff A on 09/01/10 at 12:40 PM.