Loss Prevention

A 47 year-old male with a diagnosis of schizophrenia was hospitalized with a psychotic episode. He was placed on a new medical regimen. His behavior became increasingly erratic and violent. He was placed in a private room on the psychiatric floor and placed in leather restraints for his safety. He was checked by floor staff every 30 minutes.

Eight hours after being placed in restraints, during a routine check, the patient was found unconscious with vomit in his mouth. Attempts to turn the patient to remove the aspirate were encumbered by the leather restraints. None of the staff responding to the emergency had the keys to unlock the restraints. A crash cart with suction apparatus was brought into the room, but there were no plugs in the room as safety precaution for psychiatric patients that might otherwise injure themselves, nor an extension cord on the cart with which to plug in the apparatus.

The patient experienced a respiratory arrest. The staff began CPR and told a nurse’s aide to call a “Code Blue”. The nurse’s aide thought Code Blue was a tornado warning and began closing doors and draperies in the patient rooms.

The patient did not survive the eventual resuscitation efforts.

Section A. Risk Identification

Identify the areas of risk that you discern from the scenario you chose. Be specific and cite your sources.  1 - 2 pages, APA format

Section B.  Risk Analysis

Explain the legal ramifications of the event depicted in the scenario. Depending on your chosen scenario and the specific risks, this analysis may include determining whether a sentinel event report needs to be filed.  3 – 4 pages, APA format

Section A: Risk Identification

Among five scenarios I have chosen scenario 4. While reading this scenario, I have recognized four areas of concern that seemed to hold the highest amount of risk in this scenario. First, the patient has been vomiting which can be due to improper placement of leather restraints. If the patient is vomiting, it indicates that the restraints have been placed too tightly or in a position where vomiting may be easily induced. In addition, he may have been in the restrained position for much too long (eight hours), which may also have played a role in the vomiting. This could be easily be solved by placing the restraints in a less haphazard position. In addition, the position of the patient is also very important in eliminating the risk of vomiting. To do so, ensure the patient is in a lateral-recumbent position, preferably on the left. If this is not possible, either prone or spine would be ideal, with one arm at the side and one above the head. The patient should only be secured to either a backboard or stretcher, and never to a vehicle or immovable object so as to avoid the risk of injury. Second, the unavailability of keys to unlock the restraints during the emergency is also a major concern. This issue could have been solved preemptively by using the restraints that don’t require a key to unlock. Third, when the crash cart with suction apparatus was brought into the room, there were not any plugs available nor any extension cord to plug in the apparatus. This could have been fixed by having a spare generator or try to move the patient to some other room. Finally, the lack of knowledge of nurse on “code” terminology is merely a failure in education. There should be a series of terminology that every member of the staff should be familiar with, and failure to do so is simply ignorance, which should never be excusable.

Special considerations:

A. Restraints should be of a soft nature (e.g. leather cuffs, cravats, sheets, etc.) applied to the wrists and ankles. A restraint may also be needed across the chest and/or pelvis.

B. Make a plan before any attempt at restraint, assigning specific duties to each member of the team. Designate a team leader.

C. A show of force may initially be sufficient to gain the cooperation of the patient and is preferable to the actual use of force as a first step.

References:

Physical Patient Restraint Procedure. (n.d.). Retrieved November 5, 2015.

http://www.ejems.com/Protocols/General/restraint.htm

Section B: Risk Analysis

A legal ramification is the result of the law that one has to face after an action. For instance, after a person has stolen from a cashier and murdered her, the person faces legal ramifications of theft charges and first degree murder. According to this case scenario, the person in charge should be answerable and is liable to face legal ramifications since he did not take the required precautions to make sure that the patient would be safe with the leather restraints that were put on him even if they were initially intended for his own safety. The staff that came to respond to the patient after he was found unconscious with vomit in his mouth was not able to remove the aspirate from him as they were hindered by the leather restraints. Neither of the staff had the keys to the restraints’ lock. This could be treated as negligence as the one in charge of this ought to have considered a case of emergency as this one before leaving with the keys. He should have left the keys with the person who was taking the routine checkups on the patient. In medical practice, medical practitioners are expected to Respect human life and dignity. This is one of the most fundamental of moral principles. It states that “individuals should be treated as distinctive beings, equivalent to all other individuals” (Rawls, 1999). When related to psychiatric crisis, respect for human dignity and life means healthcare professionals should:

· Refrain from discrimination, harassment or abuse.

· Respect the lifestyle, personhood and conviction system of patient.

· Demonstrate regard for patients’ socioeconomic, psychological and physical well-being.

· Strive to uphold human dignity and life.

· Hold and respect in confidence all private information.

· Need specific legal validations for meddling with a patient’s civil liberties.

The psychiatrist and the patient relationship is one of the most extremely personal in the field of qualified health care. As a consequence, a psychiatrist’s missteps or errors in treatment can carry noteworthy costs for patients. And like any other health care provider or doctor, a psychiatrist may be answerable for medical misconduct in the occasion that a mistake harms a patient. In order to win a medical malpractice lawsuit, the patient must prove that the psychiatrist’s carelessness caused predictable harm (Varcarolis, 2013). This harm can take numerous forms, including:

· Suffering and pain.

· Charge of future treatment.

· loss of receiving capacity, and

· Loss of the capability to enjoy life.

The vital issue is whether the carelessness essentially caused the harm. This underlying link can be hard to prove, and this is an additional element that can best be recognized through the expert opinion of a qualified expert. For instance, suppose that a depressive patient is given medication that carries ideas of committing suicide as a recognized side effect, and the patient kills himself a few weeks after beginning the prescription. In such a case, a specialist witness will work to prove that the psychiatrist's malfunction to recommend a different prescription caused or was a major factor in the death of the patient.

In this scenario, the health provider in charge ought to have considered a case of emergency as this one before leaving with the keys. He should have left the keys with the person who was taking the routine checkups on the patient. In medical practice, medical practitioners are expected to Respect human life and dignity. This is one of the most fundamental of moral principles. This officer could therefore be charged with negligence and face legal ramifications which could be a jail term of fines.

The act of leaving the patient in the leather restraints placed the patient in quite a number of risks and also the lack of plugs in the room as safety precautions for the psychiatric patients that may otherwise injure themselves. This was a failure from the facilities side. According to the specific risks that can be identified from this scenario’s analysis, a sentinel event report needs to be filed. A sentinel event is an unanticipated incidence involving serious psychological or physical injury, or death or the risk thereof. Serious injuries particularly include loss of function or limb. Despite the ongoing hard work nationwide to examine and reform healthcare systems and therefore advance safety, stern errors or sentinel events still happen, and they can occur in any capacity at any time. No individual or organization is immune. Sentinel events are not restricted to poor quality organizations. Many engage highly appreciated practitioners and healthcare systems.

The incident that occurred in this scenario can be considered as a sentinel event since the medical practitioner who was in charge of the patient had placed the necessary measures that were required to safeguard the patient but however, these same safety measures turned disastrous after the emergency that happened to the patient. The event indicated a need for immediate response and investigation. Not all sentinel events happen as a result of medical errors and not all errors lead to sentinel events. For instance the case in this scenario was not as a result of a medical error as the leather restraints were as a matter of fact meant to protect the patient. A sentinel report should be filed to communicate the event up the leadership chain, and an incidence report submitted as required by the institution. Every healthcare organization has a strategy regarding revelation of undesirable events to families and patients.

References

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders. (5th Ed.). Washington, DC: Author.

Rawls, A. (1999). A theory of justice (3rd Ed.). Cambridge, MA: Harvard University Press.

Varcarolis, M. (2013). Essentials of psychiatric mental health nursing (2nd Ed.). St. Louis: Saunders.