State regulators have cited the University of Vermont Medical Center for how it used restraints on two patients who were having psychiatric crises in the emergency room.
The Department of Disabilities, Aging, and Independent Living’s Division of Licensing and Protection cited the hospital for not properly using restraints on psychiatric patients.
The hospital has submitted a formal plan to regulators saying it would prevent similar violations from happening in the future. The hospital says the plan will implemented by Dec. 30.
One of the patients, identified in the original Sept. 7 report only as “Patient #1,” was brought to the UVM Medical Center on May 24 because she was “acting so ‘weird’ that s/he was taken into protective custody and brought to the (emergency department) by police for medical clearance.”
The patient “had escalating behavior” and a nurse “was unable to de-escalate his/her behavior with verbal communication,” so staff brought the patient a stretcher with restraints. Hospital and security personnel helped the patient onto the stretcher, the report said.
In a second instance later the same day, according to the report, the hospital staff again attempted to put the patient into restraints because the patient was “thrashing around, yelling, screaming, swearing, refusing vital signs, and threatening staff.”
However, according to the report, “there was no evidence that an order for behavioral health restraints was written” by a doctor for either of the patient’s two visits. The patient’s doctor had only directed “constant observation” between the first and second visits.
The other patient, referred to only as “Patient #3,” was being held at the UVM Medical Center’s emergency room while waiting for a bed at another facility, such as the Vermont Psychiatric Care Hospital.
The hospital’s staff restrained the patient “for behaviors that threatened to harm self and others,” swinging at staff, spitting, and kicking staff, the report said. The patient pulled his/her arm out of the restraint, and the staff put them back on, the report said.
The patient later complained of being bruised during the restraint process, according to the report, but the staff did not document the patient’s allegation.
Mike Noble, the spokesperson for UVM Medical Center, said in a statement that when regulators returned to the hospital for a follow-up, “the (Division of Licensing and Protection) surveyors found us to be in compliance with Medicare regulations and therefore we were not required to file a corrective action plan.”
“However, we are committed to continuously improving the quality of services we provide to our patients,” Noble said. “This survey gave us an opportunity to voluntarily review the documentation procedure for restraints and through the performance improvement process we are implementing changes that streamline our documentation.”
The UVM Medical Center submitted an action plan to regulators saying that its leadership in the emergency department reviewed policies on restraints, and that by Dec. 9 the hospital would streamline its electronic health records to better document the use of restraints.
The plan also said the hospital would educate staff on the new restraint policies and “the expectation to document any restraint” the staff used on a patient. The new training and policies will be completed in full by Dec. 30, according to the plan.
