HospitalInspections.org

Based on review of seven open and four closed medical records, including two restraint records, it was determined the hospital failed to release a patient from restraints at the earliest possible time and included inappropriate criterion for the cessation of restraints for the same patient for one of two records reviewed.
Patient #9 (Pt# 9) was a 45+ year old patient who presented to the emergency department (ED) via ambulance after a drug overdose. While in the ED, Pt #9 became violent towards staff and (his/her) family member and was placed in 4-point violent restraints at 2130hr. Review of restraint documentation titled "Behavioral Health Restraint Flow Sheet" revealed Pt# 9 was in restraints for two hours.
Additionally, restraint flow sheet documentation for Pt# 9 did not include a description of behaviors that indicated the need for continued restraint. Documentation included a column labeled "Behavioral Response", under which "A" for "agitated" was documented for the first 30 minutes. No other behavioral description was found. For the next 1 hour and 30 minutes under the "Behavioral Response" column, staff documented "C" for "calm."
On the same flow sheet under "Evaluation of Termination", the "Behavioral criteria met for termination" was noted and documented to be "Calm" and "Follows Commands." Neither of the two criterion documented was appropriate for continued restraint as the use of restraints must be based on actual and imminently dangerous behaviors not contingent on patients' awareness or cooperation. As a result, Pt #9 was not released from restraints at the earliest possible time.