Patient placed in restraint and seclusion for period exceeding physician's authorization

University Behavioral Center was cited by the Florida Agency for Health Care Administration (AHCA) for violating regulations around CEO and organization responsibility, after finding that the “facility administration failed to enforce staff requirements related to the seclusion and restraint policy for obtaining physician orders.” The cited deficiencies relate to an incident in which restraint and seclusion interventions were initiated for a patient admitted for “bipolar disorder, oppositional defiance disorder, and poly substance abuse.” AHCA’s Medical Record Review revealed “a verbal physician’s order…for restraint and seclusion…due to a behavioral event in the cafeteria.” AHCA found that the patient was placed in therapeutic holds and seclusion for a period of time that exceeded the original hours set in the physician’s orders and that a new order for continued restraint and seclusion was not obtained by staff. This practice violated the facility’s policy for “Seclusion and Restraint” which states, “the physician order must specify…if seclusion or restraints use needs to continue beyond the expiration of the time limited order, a new order for seclusion and restraint (S&R) must be obtained beyond the expiration time-limited order, a new order for S&R must be obtained from the Psychiatrist or covering Physician.” The Director of Nursing confirmed that the restraint exceeded the original order and policy and that staff should have obtained a new order. The inspection report did not include a plan of correction.