Patient restraint overuse: Exposé reveals harmful practice at North Carolina hospital

A North Carolina hospital is making excessive use of patient restraints, a practice that has been largely discontinued at most hospitals and healthcare institutions as unsafe and harmful to patients, according to a joint report by MedPage Today and Vice News

Between July 2013 and January 2014, patients at Park Ridge Hospital in Hendersonville spent more than 80 percent of their stays in some kind of physical restraint, according to the investigation, more than 800 times the national average. 

In most psychiatric hospitals and treatment wards, the practice of restraining patients has undergone a sea change over the last 20 years. Patient deaths as the result of abusive and neglectful restraint practices spurred a movement away from the use of physical restraints. At Park Ridge, however, the most recent data from the Center for Medicare & Medicaid Services (CMS) indicated patients are placed in restraints for excessive amounts of time.

"One of the things you're taught early on is you don't restrain unless there is no other way," said Jean Ross, president of National Nurses United, the country's largest nursing union. If there is concern that a patient will harm themselves or others, she said, restraints are called for, but they are used for as little time as possible.

CMS has very strict rules around the use of physical restraints. Organizations are required to use the least restrictive restraints possible. A physician's order is necessary to put a patient in restraints and clinicians must closely monitor patients who are in restraints. An additional physician's order is necessary if patients are restrained for more than four hours.

In 2014, intensive care units across the country were urged to stop restraining delirious patients. Some healthcare workers have resorted to restraining patients who they believed were at risk for falls, but safety data has shown that restraints actually contribute to patient accidents more frequently than they prevent them.

Park Ridge has been cited on multiple occasions for deaths of patients in restraints, but both the North Carolina Nurses Association and Disability Rights North Carolina told reporters they had no idea about the situation at the hospital or its over-reliance on restraints. The hospital responded to the MedPage-Vice investigation by saying that the excessively high numbers of hours that patients spent in restraints were the result of a reporting error. Park Ridge's chief nursing officer, Craig Lindsey, told the reporter that a computer issue was artificially inflating the numbers on file with CMS, which date from 2013.

"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," Lindsay told the publications through a hospital spokeswoman. 

When asked why the hospital has not gone back and corrected the record, Lindsay told the publications it would just be too much work.

To learn more:
- read the report 
- read Medicare's guidelines for the use of restraints