HospitalInspections.org

Based on review of medical records and interviews with staff, it was determined that the hospital failed to ensure that staff are able to correctly identify the administration of chemical restraints in 1 of 19 patients sampled (MR16).

Findings include:

Review of facility policy "Seclusion & Restraint," effective May 1996, reviewed June 2020, revealed "...Chemical Restraint (Medication used as a Restraint): Chemical restraint is defined as the administration of medication for the purpose of restraint. A drug or medication when it is used as a restriction to manage the patient's behavior or restrict the patient's freedom of movement and is not a standard treatment or dosage for the patient's condition, is a chemical restraint ...the only acceptable reason for the use of ...restraint is to prevent immediate physical injury to the patient or others ...used only after alternative, less restrictive approaches to assist, contain, or support the patient have been attempted ..."

Review of MR16, "Practitioner Order Sheet," dated August 5, 2023, at 10:20 AM revealed "Zyprexa 10 mg IM now for aggression, Ativan 1 mg IM now agitation, Benadryl 100 mg now agitation."

Review of MR16, "Nurses Notes," dated August 5, 2023, at 11:00 AM revealed "Needed IM's [intramuscular medications] self-harm combative to staff."

Review of MR16, "MAR [medication administration record]," dated August 5, 2023, at 11:00 AM revealed "Zyprexa 10 mg IM now for aggression, Ativan 1 mg IM now agitation, Benadryl 100 mg now agitation."

Review of MR16, "Seclusion/Restraint Packet," dated August 5, 2023, at 11:20 AM revealed "Physical Restraint Patient tolerated hold well. No signs of distress...Patient started to hit head and fist against door and wall, verbally aggressive to staff. Patient continued to bang head on door, Patient was put in physical hold for 10 minutes and released after given IM." The "Seclusion/Restraint Packet" form included sections for the documentation of "Type of Intervention" including physical restraint, mechanical restraint, and chemical restraint. There was no documented evidence of acknowledgement that a chemical restraint was utilized. There was no documented evidence that the patient's physical/medical assessment including vital signs and physical response to restraint was assessed/monitored.

Review of MR16, "Seclusion/Restraint Packet," dated August 8, 2023, at 8:00 PM, revealed "Patient agitated and yelling from [his/her] room that staff was not 'giving [him/her] attention' banging on door and threw food tray at the wall. Staff attempted to redirect verbally but [he/she] remained agitated. MD notified and ordered Zyprexa 10 mg IM now, Ativan 1 mg IM now, and Benadryl 100 mg IM now. Patient remains physically restrained as IM meds are being prepared as [he/she] continues to be aggressive towards staff."

Review of MR16, "Practitioner Order Sheet," dated August 8, 2023, at 8:13 PM, revealed "Zyprexa 10 mg IM now for aggression, Ativan 1 mg IM now agitation, Benadryl 100 mg now severe agitation and aggression."

Review of MR16, "Seclusion/Restraint Packet," dated August 8, 2023, at 8:18 PM, revealed "IM meds administered, ordered, patient no longer combative and released from physical restraint." There was no documented evidence identifying that chemical restraint was used.

Interview on August 11, 2023, at 11:27 AM, with EMP15 indicated that he/she had recently undergone training on chemical restraints but still did not understand exactly what that meant. Interview with EMP15 further revealed "At the training a few weeks ago the nurses were told not to give the three meds together. I can't remember which three meds they were. It is when there is a change in behavior, we should re-direct the patient and offer PO [by mouth] meds first. Aggressive behavior would be if the patient is harmful to self or others. I asked the trainer to tell me what a chemical restraint was, and he/she did not clarify. I don't think the other nurses know either."

Interview on August 11, 2023, at 2:13 PM, with EMP15 indicated that patients are given IM medications when they are in danger of harming themselves, harming others, or refusing other interventions. When asked what the anticipated or desired outcome from the use of the IM medications is, EMP15 revealed "It's to control the behaviors." When asked if he/she considered the IM medications to be a chemical restraint, EMP15 revealed "Well, it depends on what you are giving and how close together [timing] and the reason you're giving it. Well, hypothetically, if giving Zyprexa and Ativan, it's not considered a restraint if part of the treatment plan." When asked if IM medications are a part of the treatment plan, EMP15 clarified "No, I meant like oral Zyprexa and Ativan. If it's IM, yes, it's a chemical restraint because it would not be part of the regular treatment plan." When asked about follow-up for the IMs, EMP15 stated "What you see, well, now, the PRNs [as needed] have a follow-up on the MAR but come to think of it, the IM are 'now' meds and there is no place to do a follow-up on the form."