HospitalInspections.org

Based on review of facility documents, medical record (MR) and interview with facility staff (EMP), it was determined Wellspan York Hospital security staff restrained a psychiatric patient with handcuffs for one of one MR reviewed (MR1).

Findings include:

Review on April 8, 2021, of the facility policy "Restraint Policy," last reviewed July 2020, revealed "Policy Statement: Wellspan Nursing is committed to reducing and minimizing the use of restraints. All patients have the right to be free from restraints that are not medically necessary. ... Definitions A. ...Violent/Self destructive behavior restraint is used in situations of unexpected, violent and aggressive behavior that presents the imminent risk of harm to the patient or others. Examples of restraints: hand-mitts, wheelchair with lap tray, enclosed bed with net, wrist restraints, lap belt, soft limb restraint, 4 point locked limb restraints, 4 point leather limb restraints, tucking a patient's sheets so tightly the patient cannot move, Geri chairs when the patient cannot easily remove the table top on his or her own. Use of all 4 side rails that prevent the person from voluntarily getting out of bed is a restraint. However, in certain situations, side rails may be used to prevent a patient from falling out of bed. Examples include recovering from anesthesia, padded side rails for active seizure precautions, and all specialty beds other than a low bed or a standard bariatric bed. ..."

Interview on April 8, 2021, with EMP1 and EMP2 confirmed the policy documented above was the facility's policy for restraints.

Review on April 8, 2021, of MR1 revealed the patient was admitted on a 302 commitment to the hospital's behavioral health unit (BH). The patient had a history of aggressive behaviors at home, was threatening family members, and was non-compliant with medications. On March 15, 2021, the patient became combative, swinging a closed fist at the security guard on the BH. Additional nursing staff and security staff approached the situation. The patient's aggression escalated. One security guard was injured and bleeding from being struck by the patient. Another security guard made the decision to place the patient in handcuffs with the intent (per documentation) of preventing any additional criminal behavior. The patient was given IM lorazepam (medication for anxiety) and diphenhydramine (sedative-hypnotic) and escorted to the seclusion room where the handcuffs were removed. The patient was then calm in the seclusion room and able to follow verbal direction. Seclusion start time was 1915 and end time was 2125.

The time in seclusion verified with EMP2 and EMP3.

Interview on April 8, 2021, with EMP4 confirmed security was trained in use of handcuffs, taser, and pepper spray. Security staff at the hospital are Wellspan employees and are not contracted through an outside agency or law enforcement agency.