Dialogue Volume 14 Issue 4 2018 - Page 31

PRACTICE PARTNER Death of man in restraints prompts inquest recommendations for hospitals, CPSO An inquest examining the death of a schizophrenic man who was held in restraints inside a locked room at a Toronto hospital prompted a number of recommendations about caring for patients in crisis. The inquest’s jury found that Nokolaos Mpelos, 65, died of heart failure after spending more than 40 hours in the hospital's emergency department in May 2013. He had a history of schizophrenia and was admitted after complaining of suicidal hallucinations. The recommendations directed at the College include the following:  mergency Department assessment of patients E presenting with mental health issues should include a formal mental status exam which in- cludes assessment and documentation of patient appearance, behaviour, speech, mood, affect, thought form, thought content, insight, judgment, and cognition.  mergency Department physicians considering a E Form 1: Application for Psychiatric Assessment should take into account information from direct assessment of the patient and corroborating infor- mation. Pre-populated forms should not be used.  hysicians should consider delirium as part of the P differential diagnosis for any patient, especially in those 65 years and older, with altered cognition or altered level of consciousness.  linicians should be aware that smoking cessa- C tion increases the impact of certain psychiatric medications. This should be considered in pre- scribing medications.  sychiatric assessment should include a full as- P sessment with a mental status exam, diagnosis, and treatment plan. This assessment should be documented in the clinical notes and records.  edical assessment during and following periods M of mechanical and/or chemical restraint should consider the risks of deep vein thrombosis and cardiac effects of restraints. Using Common Sense De-escalation tips from various health-care facilities emphasize the same sort of common sense approach. Ask patients what got them upset. Apolo- gize if you did something that inadvertently upset them. Acknowledge feelings, not neces- sarily opinions, but recognize legitimate concerns or grievances. Don’t overreact, even if the patient screams and swears. Don’t talk over them or argue back. Minimize power struggles. Make sure your body language doesn’t contradict your words. Move slowly and deliberately. Give people time to express themselves. Offer concessions in the effort to calm things down. ISSUE 4, 2018 DIALOGUE 31