HospitalInspections.org

Based on patient medical record review and staff interview, the facility failed to ensure that patients involved in emergency safety interventions are free of mental and physical abuse, in the form of tasers and handcuffs, for 2 of 5 patients (pts. N1 and N3).

Findings:
1. review of patient medical records during the survey process of 8/10/11 and 8/11/11 indicated:
a. pt. N1 had an ESI (emergency safety intervention) with staff documentation as follows: on 5/20/10 at 10:45 AM: "Ct (client) began yelling out in room. Took off clothes to masturbate in front of camera. LPN (licensed practical nurse) notified to prepare prn (as needed medication). Escalation cont. until police arrived. Ct went at officer with chair. P.O. (police officer) tasered ct--handcuffed and subdued..."
b. pt. N3 had an ESI with documentation as follows: on 5/9/11 at 5:40 PM: "Police officers on unit, pt handcuffed given IM (intramuscular) injections per Dr. orders. Pt in room with officers talking."
c. both pts. N1 and N3 were inpatients at the facility at the time of police intervention and were not in police custody, nor were they taken into custody immediately following the ESIs
d. it cannot be determined that facility staff attempted to restrain pts. N1 and N3, as facility training instructions indicate, prior to calling local law enforcement to help

2. at 3:25 PM on 8/10/11, interview with staff member NA indicated:
a. pts. N1 and N3 were not appropriate for admission to the facility due to their violent nature
b. a better assessment of patients prior to admission needs to be performed
c. it was thought that if law enforcement utilized tasers and/or handcuffs, this was acceptable
d. there has been a problem with local law enforcement reluctance in caring for mentally ill patients at the jail
e. local law enforcement refused to participate in the NAPPI (non-abusive psychological and physical interventions) training that facility staff use
f. the facility may need to hire security staff to back up nursing staff with restraint/seclusion events
g. there may be a better ESI training the facility should utilize (instead of NAPPI)
h. facility staff are not utilizing restraint techniques, as trained, prior to calling for police assistance
i. facility policies do not address appropriateness in calling for police back up

Based on patient medical record review and staff interview, the facility failed to provide adequate training of staff, in regards to restraint and seclusion of patients, with the continued/frequent request of police assistance for 3 of 5 patients (pts. N1, N2, and N3).

Findings:
1. review of patient medical records during the survey process of 8/10/11 and 8/11/11 indicated:
a. pt. N1 had:
A. an ESI (emergency safety intervention) on 5/15/10 at 3:15 PM that reads in the nursing notes: "...drew up [medication] per prn order. Took syringe down to room 109 when staff member yelled 'call 911' ..."
B. an ESI on 5/18/10 at 4:30 AM where it was noted in the medical record that: "2 officers arrived et subdued pt. [pt] went to [pt's] room with officers and was medicated..."
C. an ESI on 5/20/10 at 10:45 AM where nursing documented: "...Escalation cont. until police arrived. Ct (client) went at officer with chair. P.O. (police officer) tasered ct--handcuffed and subdued..."
D. no documentation that facility staff attempted to restrain the patient themselves, utilizing facility trained techniques, prior to calling in local law enforcement for support in the three episodes of 5/15/10, 5/18/10 and 5/20/10

b. pt. N2 had:
A. an ESI on 5/18/10 at 2005 hours with documentation in the medical record ("Nurses's Progress Notes") by staff that reads: "Deputies (3) at [facility] for assistance with pt...take patient to floor safely et (and) secure [pt] while RN (registered nurse) administers IM (intramuscularly) of Ativan..."
B. no documentation that facility staff attempted to restrain the patient themselves, utilizing facility trained techniques, prior to calling in local law enforcement for support during the 5/18/10 episode

c. pt. N3 had:
A. an ESI at 5:40 PM on 5/9/11 that reads: "Police officers on unit, pt handcuffed given IM injections per Dr. orders..."
B. an ESI on 5/9/11 from 6:30 PM to 6:55 PM where the incident report reads: "[city] police x 2" participated in the seclusion episode
C. no documentation that facility staff attempted to restrain the patient themselves, utilizing facility trained techniques, prior to calling in local law enforcement for support during the 5/9/11 episodes

2. at 4:05 PM on 8/10/11, interview with staff member NB indicated:
a. patients N1, N2 and N3 were inpatients at the time of the ESIs and were not in police custody when handcuffs and tasers were used, nor were they taken into custody at the time of the ESIs or afterward
b. besides the annual NAPPI (non-abusive psychological and physical interventions) training, a one hour refresher session was done at a nursing staff meeting in August 4, 2010
c. it is unclear what specific training took place during the 8/4/10 one hour session with staff
d. some staff members are afraid of patients who are aggressive and combative--they are afraid they will get hurt, so they are quicker to call local law enforcement as back up, or to assist with subduing patients
e. it cannot be determined that staff are appropriately/adequately trained to restrain patients admitted to the unit who may be aggressive
f. better assessment prior to admission should be performed to determine appropriateness of admission in relation to the staff training
g. the facility policies and procedures do not address calling local police for assistance