Debba99

" -- in addition to reviewing medical records, we routinely interviewed clients about what they had observed of staff interacting with agitated clients and restraining/secluding clients 1. Generally speaking, there are NO patient witnesses during restraint and seclusions....patients are instructed by staff to go to their rooms and stay there until the area is safe again. 2. These patients might be incompetent but they know "the system" and they know they'd better keep their mouths shut....remember, the system provides EVERYTHING they get, how they get it, when they get it and, (here's the kicker), IF THEY GET IT....AND, if you ever did find a patient able and willing to speak out, who would believe them? In-patient clients have a credibility problem (they're CRAZY!) Suppose you did find some "fishy" documentation (I'm sure it's not easy to come by because administration puts a great deal of time and resources ensuring the documentation you see has been screened, and combed out...and all the knots have been removed) Suppose some "fish" did get by the "big dollar white collar" what would you do (or have you ever done in the past) to protect that patient from future retaliations? Get real! If staff can't speak out without retaliations, do you really think the patients can? 3. You and your staff may be experienced psych clinicians (probably in the "real world") but my guess is, you've never worked in a unionized, state run, in-patient, psych hospital (where "whatever happens inside, stays inside"). 4. Check the workman's comp records and interview the employee that went out on comp. Find out how the employee got hurt. If it was patient related, make sure there was documentation in the patient's chart re the incident. (A unit can cut down on the number of restraints and seclusions reported if the only documentation is on the restraint/seclusion (R/S) report packets and not in the patient's nursing note). Review those restraint and seclusion packets (the ones that make it back to the charts, that is). If staff names are not on the documents identifying their role...step by step...in the R/S, suspect something "fishy" because the facility isn't looking at improving staff interactions and preventing R/S. Check to see if the injuries match the step by step roles of each participant in the R/S. (Ever wonder how a patient can sustain a knee injury if the "staff followed R/S protocol as outlined by the facility's procedures"? Now, suppose the R/S documentation packet forms don't make it back to the patient's chart.....how are you to know the R/S ever happend? Check to see how the facility follows up on their CMS training. My experience: they don't; until something goes (dead) wrong. 5. If a patient gets cut or bruised during a restraint, and if an incident report ever does get written up, what do you think happens to those reports once those cuts and bruises heal up? Do you review incident reports? If not, why not? 6. There are just too many ways to manipulate a hand written document. It's much more difficult to tamper with computer documentation; and there are more efficient methods of monitoring for this conduct. In the meantime, video monitoring and undercover staff will help the legitimate worker stay alert and interacting with patients in a therapeutic and productive manner. 7. Look at the overtime records and payroll. How can a staff member be therapeutic and productive if he/she's working double shifts 4-5 days a week; month after month, year after year. What happens to that employee after an injury? How is the trauma resolved? Does the worker feel like he/she is just a "punching bag" or does he/she feel like a contributing member of the treatment team? How many employee suicides have occured in the facility? How many patient suicides have occurred in the facility? What therapy is given (documented) to staff and patient survivors? 8. The Department of Health is really good at investigating and uncovering problems AFTER serious injuries and deaths come to their attention (not all states are required to report serious injuries and deaths; so if a patient, has no family or friends monitoring their care, these states can reasonably be assured, they won't be investigated) 9. Society, in general, doesn't want to know what goes on behind closed doors in behavioral health in-patient hospitals that care for the seriously mentally ill segment of the population; except that they be kept away from the rest of "us".

I find the word "takedown" more commonly used in certain parts of the country rather than the experience of the practitioner.

Just how do you "enforce" these rules as outlined by the Fed Gov? By simply checking the facility's paperwork allows facilities to fabricate documentation. The facility I worked at were very good at producing "quality" paperwork but in reality, these union staff workers used excessive force and excessive usage of restraints without interventions because the staff were too busy attending to their own needs; eating, reading, watching tv, smoking, talking amongst themselves, sleeping to intervene early on....and re seclusions: they didn't even bother to document; just stick'em in the room and lock the door. Oh, and speak out for patient rights and you'll find yourself the target of retaliations. You want to know how to really enforce these rules: put video cams in these facilities (we did it anonymously) and you will be horrified for years to come!