HospitalInspections.org

Based on a review of patient #1's (P1) emergency department record, it was determined that P1 was restrained in 4-point restraints from 1530 through 1615 without orders to do so.

Patient #1 was an adult who presented via police to the emergency department in March 2018 following manic and increasingly angry behaviors in the community. Physician documentation of 1430 revealed in part, "Patient is irate at the time of ED arrival. Quite difficult to examine ..."

Documentation revealed that at 1530, "Restraint Monitoring 15 Minute" began and continued through 1615. Record review revealed that restraints were not actually ordered until 1855, approximately 3.5 hours after the time of initial restraint. Because the order was written after the restraint episode had concluded, it was impossible to determine when the patient was actually placed in restraints.

Based on a review of patient #1's restraint record in the emergency department, it was determined that the physician failed to specify whether to continue or terminate restraint.

Patient #1 was an adult who presented via police to the emergency department in March 2018 following manic and increasingly angry behaviors in the community. Physician documentation of 1430 revealed in part, "Patient is irate at the time of ED arrival. Quite difficult to examine ..."

Documentation revealed that at 1530, "Restraint Monitoring 15 Minute" began and continued through 1615. A physician face to face with a time of 1500 revealed no response to the question of whether to continue or terminate restraint. Documentation stated in part, "The patient was able to voice an understanding of the behavior necessary for termination of the ongoing behavioral restraint: Yes." However, documentation revealed that P1 continued in restraint until 1615.

Because the face to face was timed before the restraint documentation, and the order was written 3.5 hours later, it was impossible to determine when the patient was actually placed in restraints. See also tag A-168.