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Based on medical record and policy review it was determined that the clinical staff failed to discontinue restraints at the earliest possible time, assuring the patient ' s right to be free from restraint.

The findings include:

Administrative Policy #ADM 03-032, entitled ' Use of Restraint/Seclusion, ' last reviewed and revised April 2013, included the following listed under Goals, " 11. When restraint/seclusion is the appropriate intervention, it is to be used for the shortest period of time necessary to enable the individual to effectively cope with his/her environment or situation. Restraints/Seclusion shall be discontinued as soon as the reason for placement has ceased and it is safe to do so. "

It was determined Patient #1 with a diagnosis of schizophrenia had an arrival date of December 16, 2012 at 18:30[6:30 PM] to the facility's emergency room with a documented "history of present illness" of acute onset of altered mental status. Patient #1 was initially placed in restraints at 19:15[7:15 PM] on December 16, 2012 and discontinued at 07:00[7:00 AM] December 17, 2012.

A nursing restraint/seclusion flow sheet was completed while the patient was in restraints. The form was filled out by a nurse who indicated that safety checks were performed every hour from 19:15[7:15 PM] on December 16, 2012 through 07:00[7:00 AM] on December 17, 2012. During the 12-hour period, behavior observations made by the nurse while the patient was in restraints and documented using a numeric system. The handwritten form documented the time restraints were initiated until they were discontinued with the staff member filling out the form used codes 12 and 13 (12 = Resting and 13 = Quiet) indicating the patient was resting and quiet during the hourly safety checks.