PV's guide to B+D. This is a joke. Another fine flagship of NATSAP.
Guidelines and Procedures for the Use of Seclusion or Mechanical Restraint
POLICY STATEMENT: It is the policy of Peninsula Village that seclusion and mechanical restraint will be used only as an emergency measures within acceptable guidelines. Seclusion or mechanical restraint are only used to protect a patient from self-harm or to prevent harm to others.
DEFINITIONS:
Seclusion: The involuntary confinement of a person alone in a specified area where the person is physically prevented from leaving.
Mechanical Restraint: Any method of mechanically restricting a person’s freedom of movement, physical activity, or normal access to his/her body.
NOTES:
This policy/procedure does not apply to physical holding or to the comforting of children. This policy/procedure does apply to the use of the restraint jacket, even when the restraint jacket is used only to
safely transport a patient from one location to another location.
The only forms of mechanical restraint used at Peninsula Village is the body net, 4 point restraint used in conjunction with the body net, and the restraint/transport jacket.
Peninsula Village employs three forms of seclusion/restraint: standard seclusion, physical holding, and mechanical restraint. The most appropriate intervention for a specific patient is based on the evaluation of the following factors:
diagnosis, present clinical picture, present medical condition, and past history of abuse and other traumatic experiences.
PHILOSOPHY:
1. The commitment of Peninsula Village is to prevent, reduce, and strive to eliminate the use of seclusion and mechanical restraint. Our goal is to prevent emergencies that have the potential to lead to the use of seclusion or mechanical restraint whenever possible
and we strive to raise awareness among staff about how seclusion or mechanical restraint might be experienced by the patient.
2. A copy of this policy will be provided to the patient and to the parents/guardians upon the admission of the patient to the program. Written acknowledgement of the receipt of the copy of the policy will be placed in the medical record.
3. Except in an emergency, non-physical measures will be attempted before seclusion or mechanical restraint is implemented.
4. Seclusion and mechanical restraint will only be used when there is an imminent risk of a patient physically harming self or others,
including staff.
5. Seclusion and mechanical restraint will be discontinued as soon as safely possible.
6. All use of seclusion and mechanical restraint will be in accordance with the needs and rights of the patients and in compliance with acceptable standards of care.
7. Performance Improvement initiatives will address reducing incidents of seclusion and mechanical restraint.
8. A risk assessment for aggressive behaviors is completed on all patients upon admission.
GUIDELINES AND PROCEDURE:
1. Seclusion and mechanical restraint will not be used as a convenience to staff, as a punishment or discipline, or as retaliation by staff, or in a way that causes undue discomfort, harm or pain to the patient.
2. All staff who implement and apply seclusion and mechanical restraint will be trained and competent in the proper technique and
procedure and will maintain current CPR certifi cation.
3. Any use of seclusion and mechanical restraint will take into account the medical condition, any physical disabilities, and any
significant treatment issues of the patient.
4. Patients requiring seclusion or mechanical restraint will be assessed by the ordering clinician (Psychiatrist, Certified Nurse
Practitioner, or Psychologist). Documentation of this assessment will include the patient’s behavior, interventions implemented
to decrease the behavior, and the patient’s response to these interventions. If an ordering clinician is not readily available, this
assessment will be completed by an RN and the findings will be discussed with an ordering clinician within one hour.
5. Each order for seclusion or mechanical restraint will be no longer than 2 hours in duration. If continuation of seclusion or mechanical restraint is necessary the ordering clinician will be notified to obtain further orders. The ordering clinician will conduct an in person reevaluation at a minimum of every 4 hours for the duration of the seclusion or mechanical restraint. The RN may not accept seclusion or mechanical restraint orders from an ordering clinician that are PRN or that are not time-limited.
6. All verbal orders for seclusion or mechanical restraint will be co-signed by the ordering practitioner within 24 hours when possible
or the next business day that the practitioner is present.
7. If used as a response to emergent dangerous behavior, seclusion/mechanical restraint can be initiated by the RN. The ordering clinician will be notified immediately and an order obtained.
8. If there is a change in the form of mechanical restraint used, such as starting with the body and later adding 4 point restraint, a new
order will obtained from the ordering clinician.
9. An approved Licensed Independent Practitioner (Psychiatrist, Certified Nurse Practitioner, or Psychologist) as defined by the State
of Tennessee and as allowed by the organization will perform a face-to-face evaluation and document the assessment within one
(1) hour of the initiation of the seclusion or mechanical restraint. It is the expectation of the organization that the Psychiatrist will
be the first option for conducting face-to-face evaluations and the other Licensed Independent Practitioners will only be used if the
Psychiatrist is unavailable. Further, it is the policy of the organization that all face-to-face evaluations conducted by a Psychologist will be done in conjunction with a RN.
10. A note describing the clinical justification for the use of seclusion or mechanical restraint will be written in the progress notes section of the order sheet by the ordering clinician. If the ordering clinician is not the attending MD or Certified Nurse Practitioner, the attending MD or Certified Nurse Practitioner will be notified as soon as possible but no later than the next working day.
11. The safety and privacy of a secluded or mechanically restrained patient is maintained by providing for their seclusion or mechanical
restraint in an area separated from other patients. The patient will be searched prior to being placed in seclusion or mechanical
restraint. This is to be documented on the appropriate forms.
12. The patient will be informed of the behavioral criteria necessary for release. Seclusion or mechanical restraint will be discontinued
when the patient meets the behavior criteria for discontinuation.
13. After placing the patient in mechanical restraint, the RN will assess for proper application of restraining devices, for proper
anatomical position, movement, circulation, neurological condition, respirations, any negative effects of mechanical restraint as well
as any signs of distress. The results of this assessment are to be documented on the appropriate forms.
14. Any patient in seclusion or mechanical restraint will be constantly attended to by staff. Documentation will occur at least every 15 minutes. This check will include an assessment of the patient’s condition and needs as well as interventions used. This is to be documented on the appropriate forms.
15. Every hour the RN will assess a patient in mechanical restraint for proper application of restraining devices, for proper anatomical
position, movement, respiration, circulation, signs and symptoms of hypo or hyperthermia and neurological condition. The results
of this assessment and any interventions initiated are to be documented on the appropriate forms.
16. Range of motion assessment will be performed hourly for those patients in mechanical restraint.
17. The patient is to be offered toileting, fluids and/or nourishment at least every hour. If a patient on the restraint bed is given food
or fluids, the head of the bed is to be raised. This is to be documented on the Seclusion/Mechanical Restraint Flow Sheet, using the appropriate codes.
18. At the end of the specified time limit, the ordering clinician is to reassess for the need for continued use of seclusion or mechanical
restraint. If the ordering clinician is not available, the RN can perform this assessment and the order may be obtained by phone.
19. Upon release from seclusion/mechanical restraint, the RN will document the patient’s mental/physical condition, response
to intervention and any verbal contracts made with the patient. If seclusion/mechanical restraint is discontinued prior to the
expiration of the original order, a new order must be obtained prior to reinitiating either, with all the same requirements as the
original order.
20. Clinical or nursing staff will notify the family/guardian of any seclusion or mechanical restraint within twelve (12) hours.
21. A Life Space Interview/Debriefing will be attempted with the patient after the seclusion/ mechanical restraint.
22. The Quality/Risk Management Department will keep a record of all seclusions and mechanical restraints.
23. Leadership staff and performance improvement staff will review all uses of this procedure. Quality Management staff will be
involved in data review and staff education as appropriate. Data reviewed will include both medical record review (quality of
documentation) and data which reflects occurrences, trends, patterns, and appropriateness of utilization of this procedure.
Performance Improvement data will include at least:
shift,
staff who initiated the process,
the length of each episode,
date, time and day of the week each episode was initiated,
the type of restraint used,
whether injuries were sustained by the individual or staff, and
age and gender of the individual.
24. Within 24 hours of the initiation of the seclusion or mechanical restraint, an incident review will be conducted to determine the
circumstances that required the use of the intervention, what could have been done differently that could have possibly prevented
the intervention, identification of strategies to prevent the reoccurrence of seclusion or mechanical restraint, opportunities for
performance improvement, and any indication of staff or patient physical/psychological trauma associated with the incident that
needs to be addressed. The review will include both staff who were involved in the incident as well as staff not involved in the
incident.
25. Any death or serious injury resulting from or related to the use of seclusion or mechanical restraint will be reported within one
business day to the Tennessee Department of Mental Health and Developmental Disabilities, the Disability Law and Advocacy
Center of Tennessee, and the Centers for Medicaid and Medicare Services or its agents. (How easy would it be for PV to cover up injuries with a hospital also owned by Covenant Health at their disposal?)
REFERENCES: Tennessee Department of Mental Health and Developmental Disabilities (TDMHDD)
The Joint Commission
The Center for Medicaid and Medicare Services (CMS)
There is no mention of chemical restraints...TDMHDD did tell me PV was using them, they were "allowed" to.
I knew I was wasting my time with the TDMHDD, they actually endorse PV. It would be embarrassing to the department for their prize child farm to be revealed as a hellhole - might even leave them legally exposed.
PV stinks to high hell. It's a prime example of a NATSAP program: it's a sham, with a glossy website presenting a Summer camp facade. Everything about the place crumbles under the most casual scrutiny. Clinicians and staff are liars (gotcha on tape) and unqualified, their "outcome studies" showing success are a joke, and their admissions criteria is for show. Violent/sexual offenders are admitted, individuals convicted as adults - Andrew Klepper, the kid who sodomized a call girl with a baseball bat, robbed her and threatened her. Tennessee did not even want Klepper in the state, but PV's therapist Jean Bolding refused to deliver a letter from a Maryland court demanding his return. Klepper recently violated his original probation when he was charged with "pandering", basically he was involved with a prostitute who may be very lucky they were busted before Andy started trying to get his kicks. Klepper's story isn't written up in Village Voices, he's certainly not a testament to the efficacy of PV's treatment. Dominic Harwanke, convicted as an adult for conspiring to commit a Columbine-style attack on a high school...the unnamed 17 yr. old from Powell, TN, who had a bomb he intended to use on his school...
There are more examples straight out of the newspapers, but the point is PV, a NATSAP program, misrepresents itself across the board in order to suck $8700 a month out of parents dumb enough not to do a little homework and ask for some proof of "success". My wife asked the clinical director about the outcome studies showing success and questioned the database. The clinical director lost his temper and snarled "Why are you asking these questions?" Like I said, the slightest scrutiny exposes the myriad lies, smoke and mirrors PV depends on.
