Death in Seclusion and Restraints

You may be asked to consult on a case involving a death in seclusion and restraints. The use of seclusion and restraints has fallen off in recent years, as healthcare practitioners have become aware of their dangers. Here is what can happen:

Case of death in seclusion and restraints

A forty-six year old man with a diagnosis of schizophrenia was picked up by the police because he was yelling at people at a number of businesses. The patient was aggressive in the ambulance, where the squad members restrained his arms and legs. He was very agitated, delusional and aggressive.

When he got to the hospital, the patient tested positive for amphetamines. The on call physician gave a telephone order for seclusion and restraint, one–to-one monitoring by audio and video, and an IM injection of Zyprexa 10 mg.

The staff put soft leather restraints on him. After about two hours, the staff contacted the physician and informed him that the patient had not gotten any benefit from the Zyprexa. The physician ordered a second dose of Zyprexa 10 mg and added Ativan 2 mg.

After these medications were given to him, the patient began having periods of snoring. The staff found him dead. The cause of death was acute methamphetamine intoxication.

The plaintiff alleged negligence in the monitoring and restraining of the patient. The plaintiff claimed that the psychiatric facility staff ignored the fact that the patient tested positive for methamphetamine and should have physically checked on him while in the seclusion room. The case settled for $1.25 million in April 2014.

Prevention of a death in seclusion and restraints

The Joint Commission, Centers for Medicare and Medicaid Services, and State Departments of Health all have something to say about prevention of a death in seclusion and restraints.

When there is a discrepancy between the regulatory agencies, the most restrictive rules apply.

What went wrong here in this case of death in seclusion and restraints? Here is what I see:

• There is no indication that the staff tried less restrictive measures before putting the patient in seclusion.
• The combination of medications may have resulted in oversedation.
• The staff relied on watching the patient through a video camera instead of being in the room with him.

Hospitals are required to report to CMS all deaths associated with the use of restraints and seclusion. The death might have occurred while the patient was in restraints or seclusion or within 24 hours after being removed from restraints or seclusion.

Additionally, the death has to be reported if it occurred within a week after restraint or seclusion and it is reasonable to assume that seclusion or restraints could have directly or indirectly contributed to the death. The case described above would have been a reportable one.

This death in seclusion and restraints was avoidable.

Pat Iyer MSN RN LNCC is president of The Pat Iyer Group. Get more details about the standard of care by investing in a copy of Death in Seclusion or Restraints, an audioprogram prepared by Dr. Wanda Mohr.