HospitalInspections.org

Based on record review and interview, nursing failed to ensure the Registered Nurse (RN) was completing a comprehensive nursing assessment, obtaining vital signs, and assessing the patient for adverse reactions or effectiveness of the administration of psychotropic medication administration administered as a chemical restraint/ emergency behavioral medication (EBM) on 2 (#6 and #7) of 2 patient charts reviewed.

A review of patient #6's medical chart revealed the following verbal physician orders for the administration of psychoactive medications as a chemical restraint.

8/14/24 @1910- Haldol (psychotropic) 5 mg IM, Benadryl (Antihistamine) 25mg IM, Ativan (sedative) 2 mg IM for agitation and EPS.
8/15/24 @1310- Thorazine (psychotropic) 50 mg IM and Benadryl IM, and physical hold for aggression and EPS.
8/15/24 @ 2218- Thorazine 25 mg IM, Benadryl 50mg IM, and Ativan 1 mg IM for severe aggression.
8/16/24 @ 1430- Thorazine 50 mg IM and Benadryl IM, physical hold and seclusion for aggression and EPS.

A review of patient #6's chart revealed there was no documentation on how the patient was monitored, assessed for adverse reactions, vital signs, or effectiveness of the psychotropic medication administered as a chemical restraint/ emergency behavioral medication (EBM)

According to www.accessdata.fda.gov There is no specific antidote for Haldol or Thorizine. The possibility of respiratory depression and multiple drug involvement should be considered. Close medical supervision and monitoring should continue until the patient recovers.

A review of the restraint packet revealed a section "Activity/Behavior During Seclusion and Activity and Behavior Post Seclusion." The area allowed the writer to document the patient's behaviors and activities for seclusion only. There was no specific place to put a nursing assessment of the patients in physical restraints, holds, or chemical restraint administration. There was no documentation of when the nurse returned to monitor the patient, how often, or for how long after patient #6's chemical restraint administration.

An interview was conducted with staff # 2 on 8/27/24. Staff #2 confirmed that there was no policy or process developed to determine how the patient would be monitored or assessed after the administration of a chemical restraint. Staff #2 stated that the patients are being monitored by the nursing staff however, there needed to be a place and process on how and where to document in the restraint record.


40989

Findings:

Patient #7 was an 11-year-old female admitted to the facility on 8/09/2024 with a diagnosis of Disruptive Mood Dysregulation.

A review of the document titled, "Restraint/Seclusion/Emergency Medication Order and Documentation" dated 8/10/2024 at 1945 (7:45 PM) by RN Staff #8 was as follows:
"8/10/2024 ... Type of Intervention: Physical hold, Emergency Medication, and Seclusion.
Medications: Zyprexa (antipsychotic) 5 milligrams (mg) Intramuscular (IM) for severe agitation and Benadryl (an antihistamine drug that has a sedating effect) 25 mg IM ..."

A review of the medication administration record confirmed RN Staff #8 administered the emergency behavioral medication/chemical restraint on 8/10/2024 at 8:35 PM.

A review of the restraint packet revealed there was no documentation of an assessment by the RN after the administration of the emergency behavioral medications/chemical restraint.

An interview was conducted with Staff #2 on 8/27/2024 at 10:45 AM. Staff #2 confirmed the facility policy titled, "Restraint and Seclusion" did not instruct the RN when or how often to monitor a patient after the administration of a chemical restraint/emergency behavioral medication.