HospitalInspections.org

Based on record review and interviews, the facility failed to assure that the Medical Director and the Director of Nursing (DON) adequately protected the rights of patients who were placed in seclusion and/or restraint. Specifically the Directors failed to ensure the proper use of Seclusion and Restraints (S&R) for 1 non-sample patient (N2) added for review of S&R. The facility failed to follow proper release criteria for S&R for patient N2, thereby keeping patient restrained longer than necessary. The facility also failed to ensure the use of the least restrictive methods for external control of aggressive and agitated behavior based on individual patient findings/needs for 1 active sample patient (A2) and 2 of 3 non-sample patients added for review (N2 and N3). The facility had used chemical restraint for episodes of patient agitation, and had no policy and procedure in place to support the use of chemical restraints. No evaluation of patients in restraint was done, because the facility did not consider the choice of medications and dosages to be chemical restraint. Facility staff did acknowledge that the medications would have a "sedating" effect, and the medication combination used was one usually used as a regular order set for Emergency Medications for any patient given the medications when agitated. This failure exposed patients to potential harm from unnecessary chemical restraint and jeopardized patients' rights to safe treatment in the least restrictive manner possible. (Refer to B144 and B148)