HospitalInspections.org

Based on a review of 12 patient records, it is revealed that the hospital failed to protect patient #6's right to refuse treatment.

Patient #6 is a young adult female who presented via family to the emergency department (ED) in late July 2014 due to bizarre behaviors. A nursing note of 0052 states " Pt with desires to complete a "mission" and needs to attend ceremony outside. Pt not following directions attempting to leave unit and is current EAP by Dr. __. Pt is without reality and is violent toward staff. No relief with IM meds, pt restrained."

Patient #6 was placed in 4-point neoprene (violent) restraints and was given intramuscular antipsychotic and anti-anxiety medication at 0052 when she stated her intention to leave the ED. While physician documentation reveals the mother's statement that she would make out an emergency petition, no State of Maryland Emergency Petition documents are found in the record to supersede the patient right to leave the ED. Additionally, no Capacity statements are found indicating that patient #6 had a temporary incapacity allowing the hospital to treat patient #6 against her will. Therefore, having failed to conduct these processes making it possible to retain and/or treat patient #6 against her will, the hospital failed protect patient #6's expressed right to refuse treatment.

Based on a review of policy and procedure, and 12 patient records, it is revealed that 1) orders for restraint of patient #5 were not written immediately or as soon as possible, and 2) those orders were written for violent (neoprene) restraint, though patient #5 is documented as being in non-violent (soft) wrist restraint.

Patient #5 is an adult male who presented in early July 2014 to the emergency department at 1800 due to an intentional drug overdose mixed with alcohol. Patient #5 was intoxicated on arrival, and seen by the physician. At 1915, patient #5 is noted as trying to remove the nasal cannula, monitor wires, and his IV while still intoxicated. Physician order documentation at 2358 reveals two orders for "ED Behavioral Management Restraint Neoprene Wrists 2 Hours Childrens". RN restraint monitoring documentation reveals that patient #5 was placed in "soft wrist" restraint from 1915 through 2350. Based on this information, patient #5 was 1) restrained for 4 hours and 35 minutes without orders, and 2) Physician orders and nursing documentation are inconsistent regarding the type of restraint used. Therefore, clinical staff fails to differentiate between violent restraints which might have been utilized for patient #5 who was otherwise documented by nursing as being in non-violent soft wrist restraints.

Based on a review of 12 patient records, it is revealed that a face to face restraint assessment for patient #5 was not completed, and the face to face element of whether to continue restraints was not addressed for patient #6.

Patient #5 is an adult male who presented in early July 2014 to the emergency department at 1800 due to an intentional drug overdose mixed with alcohol. At 1915, patient #5 is noted as trying to remove the nasal cannula, monitor wires, and his IV while still intoxicated. He was placed in 2-point wrist restraints. Patient #5 was seen by the physician at 1935 for a medical evaluation. However, no face-to-face documentation appears in the record specific to the fact that patient #5 was in restraint.

Patient #6 is a young adult female who presented via family to the emergency department (ED) in late July 2014 due to bizarre behaviors. A nursing note of 0052 states, " Pt with desires to complete a " mission " and needs to attend ceremony outside. Pt not following directions attempting to leave unit and is current EAP by Dr. __. Pt is without reality and is violent toward staff. No relief with IM meds, pt restrained. "
Patient #6 was placed in 4-point neoprene (violent) restraints and was given intramuscular antipsychotic and antianxiety medication at 0052 when she stated her intention to leave the ED. A physician medical screening exam is noted in the record concurrent to patient #6's restraint process, which addresses most of the face to face elements. However, no physician face to face documentation as to whether to continue restraints is found.