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Based on a review of patient #3 's record, it is revealed that during a restraint event lasting 6.5 hours, only one restraint order was found.
Patient #3 was a middle-aged male who presented via ambulance to the emergency department (ED) in early August 2016. On entry to care, patient #3 was combative, swinging at staff, kicking and spitting. He was placed into 4-point restraints at 1630 which continued until 2300. A new order for continuation of restraint was due at 2030, based on a 4-hour restraint order.
A physician note of 2133 stated in part, " ...I have renewed his restraints order..., however, no renewal of restraints is found. Based on this, patient #3 was kept in restraints for 2.5 hours without an order.

Based on a review of patient #3 ' s record, it is revealed that subjective behavioral documentation, and no specific discontinuation criterion by which to justify continued restraints.
Patient #3 was a middle-aged male who presented via ambulance to the emergency department (ED) in early August 2016. On entry to care, patient #1 was combative, swinging at staff, kicking and spitting. He was placed into 4-point restraints at 1630 which continued until 2300, a total of 6.5 hours.

At 1800, patient #3 was documented as falling asleep between periods of agitation. At 1900, nursing removed the right wrist restraint although no documented change in his " agitated, restless " behavior was noted. At 2132, the left ankle restraint was removed, although patient #3 continued to be documented as " agitated, restless, " again with no change noted. Neither agitated nor restless behavior of themselves are criterion for restraint use or continuation.

At 2301, the last two restraints were removed although nursing alternately documented that patient #3 continued to be an imminent danger, yet was also asleep. Criterion given to patient #3 (every 15 minutes) stated only, " absence of specific behavior, " though detail of the specific behavior is not found.

Overall, documentation did not appear to reflect objective, real-time descriptors of patient #3 ' s behaviors, and the restraint period of 6.5 hours was not clearly justified.