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Based on interview and documentation review it was determined the Hospital failed to ensure all patients have the right to be free from physical abuse and/or restraint imposed as a means of discipline in one of two applicable medical records reviewed.

Findings included:

Documentation review indicated the Patient had been brought to the Hospital ' s ED by his/her parents, after reporting he/she had drunk antifreeze. The Patient refused to say how much antifreeze had been ingested and admitted to attempting self harm. The Patient was not answering questions appropriately and was placed in an ED treatment room with 1:1 observation provided. The ED Attending Physician assessed the Patient and ordered IV access established and blood and urine samples collected for laboratory testing. IV access was established with the help of a nursing staff member holding the Patient ' s arm and a Hospital security staff member being present. A nursing staff member explained to the Patient why a urinary catheter was needed and how it would be inserted and the Patient had verbalized understanding; however he/she became uncooperative and combative when an insertion was attempted. The police were called for assistance and responded to the Hospital. With two police officers at the Patient ' s bedside a urinary catheter was insertion; however the Patient was combative during the insertion procedure as he/she grabbed at the urinary catheter, pulled out the IV access device and was kicking and thrashing around at which point one of the police officers tazed the Patient twice. An injection of 5 milligrams (mg) of Haldol (antipsychotic) and 2 mg of Ativan (anxiolytic) were administered and the IV access device re-established.

The Attending ED Physician was interviewed in person on 7/19/10 at 9:35 AM. He/She said the Patient was definitely psychotic and was becoming more agitated as time went on. A urine sample needed to be obtained to determine if the Patient had ingested antifreeze and if there were any emergent medical issues as a result. He/she said we had needed to restrain the Patient, who was a very large and strong individual, and the local police had been called for assistance. He/She said he/she did not want patient ' s tazed but to prevent injuries it might be needed and the police make that determination. He/she said there had been 3 instances in the last 5 year when a patient had been tazed while in the ED by police offers. Two of the Patient had not been in police custody at the time.

The Charge Nurse was interviewed in person on 7/19/10 at 8:10 AM. He/She said although he/she had not seen a tazer used on a patient before he/she had heard of other instances when they had been used by police called to assist in the ED. He/She said he/she thought utilizing a tazer on a patient depended on the situation and was judgment call. .

Based on interview and documentation review it was determined the Hospital failed to ensure the data collected related to the use of restraint included data that allowed for the monitoring of the effectiveness and quality of care provided as it related to restraint use.

Findings included:

Restraint data and analysis documentation, collected for January 2010-June 2010, was reviewed. The data was reviewed however the only analysis that was performed related to the completion of the medical record documentation and the nursing unit where the restraint was utilized. The data analysis did not included the time of day the restraint was utilized and/or any patterns of use, the reason for the restrain (behavioral or medical), the type of restraint utilized or if local police were called for assistance.

The Director of Risk Management was interviewed in person on 7/19/10 at 2:45 PM. He/She said the data collected for restraint utilization was only utilized to review number of restraints used by unit by month and if the medical record contains appropriate documentation. No other data on restraint utilization was collected and/or analyzed.