HospitalInspections.org

Based on review of hospital policies and 8 closed and 6 open medical records including three restraint patient records it was determined that the hospital failed to release patient # 14 and # 13 from restraints at the earliest possible time.

Patient # 14 was a young adult who presented to the hospital on an emergency petition for suicidal ideation. Patient # 14 was admitted to the behavioral health unit (BHU). During patient's time in the BHU, patient #14 was restrained six times for violent behavior. Patient #13 was not released at the earliest possible time for five of those episodes.

For example, for restraint episode #1, patient #14 was placed in restraints at 1850 for combative and threatening behavior. Per a document titled "Assessment While in Restraint/ Seclusion" patient was described as resting quietly at 1920. At 1935 it was documented patient "remains calm & cooperative, restraint reduced LLE (left lower extremity)." Fifteen minutes later patient # 14 was described as still being calm and cooperative and the right upper extremity was removed. At 2010 the left upper extremity was removed and at 2015 the right upper extremity was removed. Patient was described as being calm and cooperative for one hour before restraints were completely removed.

Patient # 13 was an adult patient who was brought to the hospital on an emergency petition for suicidal ideation. While in the emergency department, patient #13 became combative towards staff. Patient #13 was placed in 4-point (limb) violent restraints at 1440 and released at 1600. Per ED provider documentation at 1527 the patient was resting comfortably. At 1530 the LPN documented that the patient "appears to be sleeping," "restless." The right lower extremity restraint and the left upper extremity were removed at this time. The need to continue the use of restraints was documented as "Yes." At 1600 the remaining restraints were removed.

The practice of gradual release was also found in the hospital's restraint policies regarding violent restraints titled "Restraint Use: Violent/Self Destructive Behavior Behavioral Health Unit" (revised May 2016) and "Restraint Use: Violent/ Self-Destructive Behavior" (revised April 2017). In both policies it is stated that "When multiple limb restraints are in place, consider (based on patient condition) the release of restraints in stages ..."
In summary, patients are not being released at the earliest possible time when restraints are reduced in this manner.