CUMBERLAND COUNTY, Pa. — A hospital in central Pennsylvania has been cited by the Pennsylvania Department of Health following an investigation into the death of a patient who was placed in restraints.
The health department concluded that Geisinger Holy Spirit Hospital staff failed “to protect the patient’s safety during restraint application.”
Other violations included the staff’s failure to ensure restraints were in accordance with the order of a physician or practitioner and the failure to report a death to the appropriate authority within a week of the incident, the health department report states.
The incident occurred on September 26 when an unnamed patient attempted to push past security guards and leave the hospital, according to the health department. At that point, the patient was restrained and forced back into bed. The guards then attempted to hold the patient down while the nurse and doctor tried to place restraints on the individual, the report says. Eventually, the patient went limp, seemed to be foaming from the mouth and turned blue — becoming completely unresponsive. A code blue was announced but the patient could not be revived.
The hospital determined that the patient died from “diffuse anoxic brain injury,” the report adds.
In response to the report, Holy Spirit submitted an action plan which includes staff education on restraint application and the reporting of deaths to the appropriate authority, creation of a code grey team, restraint logs and auditing tools, the health department states.