Restraint Policy

Swedish Medical Center is committed to providing a safe environment for all patients.  Swedish seeks to provide that environment by first ensuring that care has been given to resolve physiologic, psychosocial and environmental factors that might place patients at risk for harm to themselves or others.  If the patient remains at risk after these interventions have been put into place, restraints used are the least restrictive as possible for as short a time as possible and at all times are used with respect to the patient's rights and dignity.

A Registered Nurse will initiate the patient safety protocol in the plan of care for the following reasons:

1.    The patient is at risk of harm to self or others.  Risk is identified during the patient assessment process when the patient exhibits problems or significant findings.

2.    The patient is at risk to disrupt necessary treatment, such as the patient pulling out a urinary catheter, IV, nasogastric tube or endotracheal tube.

A physical order is not required to initiate this protocol; however, a physician must personally assess the patient at least every 24 hours.

Verbal Orders

If a Clinician orders restraints, a time limited verbal or written order is required.  Verbal orders must be signed within 24 hours.  Teh order will include the reason for the restraint, type of restraint, duration of order including a start time and end time (not to exceed 24 hours) and will indicate if the order is an initial restraint order or a reorder.  A new ordered is required if a physician orders re-application of a restraint when the patient has been restraint free greater than 60 minutes and/or behavior is not related to the original episode.

13.1  Postmortem Policy.  It shall be the policy of the Hospital and Medical Staff that a postmortem examination will be actively utilized as a quality management mechanism.

13.2  Permission.  The Attending Practitioner or his/her designee is expected to request permission for an autopsy in the event of a death which meets the criteria specified herein.  If permission cannot be obtained from the family (or guardian) in such death, that fact will be documented in the medical record.

13.3 Criteria for Autopsies.

13.3.1 General Criteria.  An autopsy shall be requested: 

a. When the attending Practitioner desires to have one conducted for clinical reasons.

b.  When a death is unexplained or unexpected.

13.4.1  Autopsy Performance. 

a.  The Pathology Department shall perform all autopsies that meet the specified criteria for which valid permission has been obtained.

b.  The pathologists, in conjunction with the attending Practitioner, shall have the authority to perform limited autopsies, depending upon the circumstances of the individual cases. 

c.  A postmortem examination will be performed within 48 hours of the time that the Pathology Department receives a legal and valid permit.

 

13.4.2 Autopsy Reporting.

a.  Preliminary or provisional reports of every autopsy will be provided within two (2) days of the time the gross examination is performed.

b.  Final autopsy reports shall be completed and forwarded within 60 days of the gross examination.

c.  The autopsy report will be sent to the Attending Practitioner, the health information services department and any other treating Practitioner who requests a report.

d.  The Pathology Department will report annually to the Medial Staff's Quality Management Committee regarding Postmortem Examination activities.