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BAPTIST MEDICAL CENTER 111 DALLAS STREET SAN ANTONIO, TX 78205 Oct. 23, 2014
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0168
Based on record reviews and interviews the facility failed to ensure the use of restraint was in accordance with a physician's order and the facility's policy for one of one patients (Patient #1) restrained in the emergency department due to behavior. This had the potential to effect any patients admitted to the emergency department who may require emergency restraints due to behavior.

Findings included:

Record review on 10/23/14 of Security Officer #1's written report revealed that on "07/12/14 at approximately 1745 hours, he had to physically lead by holding the arm of Patient #1 back to her room at the request of the nurse practitioner who was evaluating Patient #1. The nurse practitioner had reported to him that Patient #1 could not leave prior to the city police arriving to execute an emergency detention due to her suicidal ideation."

Record review on 10/23/14 of the emergency department clinical record, dated 07/12/14, for Patient #1 did not reveal evidence of a physician's order for a restraint.

Record review on 10/23/14 of the facility's Restraint and Seclusion Policy and Procedure, effective date 06/24/14, revealed but was not limited to the following: "Behavioral Restraint was defined as the restriction of patient movement for the management of violent behavior that is intended to cause harm to self or others, and de-escalation techniques are not effective. Physical hold was defined as a form of Behavioral Restraint involving the application of physical force (pressure applied to an individual's body) alone restricting the free movement of the whole or a portion of an individual's body to control violent behavior. Applies to emergency Behavioral Restraint application only. Restraint shall only be ordered by a physician member of the medical staff. If an attending physician is not available, a registered nurse (RN) may initiate restraint in advance of a physician's order. In some emergency situations, the need for a restraint intervention may occur so quickly that an appropriate order cannot be obtained before the application of restraints. In these emergency situations, the order must be obtained either during the emergency application or immediately after the restraint has been applied."

Interview on 10/23/14 at 2:50 PM with Security Officer #1 revealed the nurse practitioner asked him to keep Patient #1 from leaving the emergency department because Physician #1 had ordered an emergency detention and the city police had not yet arrived at the facility to execute the order. He stated Patient #1 was in the hallway outside of her emergency room when the nurse practitioner asked him to detain her. He stated he first attempted to verbally detain her from leaving but she would not comply. He stated he then "grabbed" her left/right arm and turned Patient #1 around and physically lead her back to her emergency room and placed her on her bed. He confirmed he would define what he did as restraint because Patient #1 required physical holding to comply with staying in the emergency department.

Interview on 10/23/14 at 3:50 PM with complainant (Patient #1) stated she was physically brought back to her emergency room by Security Officer #1 against her will on 07/12/14.

During the exit conference on 10/23/14 at 4:20 PM, interview with Risk Mangers #1, #2, and #3 confirmed there was no physician's order for the restraint of Patient #1 on 07/12/14 in her emergency department record.