Restraint Use: No One Is Watching

by Sydney Lupkin: For Complete Post, Click Here…

ngd- The same is true of the use of antipsychotic medication to shut residents down…

National restraint data are riddled with errors.

After apparently setting a record for the number of hours it restrained patients — a whopping 800 of every 1,000 hours — Park Ridge Health hospital in Hendersonville, North Carolina appears to have mended its ways.

At least that is what seems to have happened according to the Centers for Medicare and Medicaid Services (CMS), which listed the hospital’s latest restraint rate as .83 hours out of every 1,000 in 2014, the most recent data available.

It turns out the data were wrong in many cases — and probably still are.

Garbage In …

There are many problems with restraint data, including differences based on the source of the data as well as internal differences within the data sources. Indeed, restraint data submitted by Park Ridge to the Joint Commission are inconsistent with the CMS data, reflecting the higher rate despite representing a more recent time period than the supposedly corrected new rate. Park Ridge’s internal January 2016 rate was somewhere in the middle of the two.

The national average is .41 hours of restraint per 1,000 patient hours, according to the latest CMS data, which covers 2014.

In our March story, Park Ridge said its high rate was reported in error, but it could not offer a more accurate estimate and had seen no need to go through patients’ charts to come up with the correct number for the 6-month reporting period at the end of 2013. At the time, CMS did not answer when we asked whether Park Ridge’s high rate was a cause for concern, whether it had ever reached out to Park Ridge about its restraint rate or whether its restraint data could be inaccurate.

The hospital’s chief nursing officer, Craig Lindsey, said in December that CMS never reached out to Park Ridge to discuss the high rate in its restraint data.

“In the Behavioral Health [unit], it is not uncommon to place patients in restraints at the start of their treatment and then remove the restraints as we stabilize the patient,” Lindsey said through a hospital spokesperson. “The error resulted from a disconnect between the way that we were documenting the removal of restraints and where our [electronic medical record] ‘looks’ for the documentation of removal.”

After submitting a public records request to the North Carolina Department of Public Health, MedPage Today/VICE News uncovered inspection reports that included various restraint-related violations over the years. Park Ridge patients had spent nearly 24 hours in restraints without a doctor’s order, sometimes without being properly monitored; a patient died in restraints and Park Ridge didn’t report it to CMS; and a non-English speaker experiencing chest pain was tackled and handcuffed by eight people instead of being restrained in accordance with hospital protocol and CMS standards.

But hospitals don’t always know the data are wrong, and federal officials don’t seem to be using them.

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