Lawsuit illustrates restraint dilemma
Restraint policies are no guarantee against injuries from falls or violence, according to a recent lawsuit. The lawsuit illustrates the dilemmas health care providers face regarding restraints, and ethicists point out that even a liberal restraint policy is no guarantee against injuries from falls or patient violence and therefore a potential consult for the committee.
Sacred Heart Hospital in Pensacola, FL, recently settled a lawsuit alleging that hospital staff did not apply a restraint to a patient even though it was warranted and authorized by a physician. The patient, a stroke victim, had been restrained both chemically and physically at the hospital during previous admissions, according to her attorney.
When she was admitted to the hospital in October 1993 for weakness and difficulty with prescribed medication, she was disoriented and repeatedly got out of bed. A doctor authorized the use of a Posey restraint, but the nursing staff did not apply it, Lindsay contends. The patient subsequently was found lying on the bathroom floor, where she had fallen and broken her hip. The hospital settled for a confidential amount in February 1997.
Lindsay describes the case as an example of neglect by nurses who did not follow the hospital’s own policy regarding the use of restraints. Hospital officials contend the incident occurred much differently and point out that the hospital had a rather typical restraint policy in 1993, not the much more strict policy in place now.
The nursing staff did, in fact, apply the Posey restraint to the patient but removed it when her husband protested, says Debbie Foshee, RN, director of quality and risk management. Both the patient and her husband were difficult for staff to work with, says Sacred Heart claims specialist Linda McWilliams, who worked on the case. She adds that the husband had removed the restraint from his wife on previous occasions.
"She was a thin little lady and had gotten out of the Posey before, so the nurses didn’t have any confidence in the restraint anyway," Foshee says. "This shows that no policy and no restraint will ever guarantee that you won’t have a patient fall. They were authorized to use it, they did, and she fell anyway."
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