10. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any signs that anything has gone wrong.
11. Mr A complains the level of restraint used against him on 9 February 2023 was excessive. Mr A explained he suffered with bruising and back pain as a direct result of the restraint used. Mr A told us the experience caused him to lose confidence and he felt he had been treated like he was nothing.
12. We are very sorry to hear Mr A felt this way. It must have been scary for him to experience this, especially as he was recovering from brain injuries and surgery. To address Mr A’s concerns, we reviewed the medical records from 9 February and relevant Trust policies in place at the time.
13. The Trust’s policy defines physical restraint as the positive use of force to protect a person from harming themselves, or others, or seriously damaging property. It is only allowed in circumstances to stop immediate danger or significant injury to the person or another individual or to avoid immediate serious damage to property, when any other course of action would be likely to fail.
14. The aim of any restraint is to maintain the safety of staff, other persons present and the person themselves by using an appropriate degree of control of the aggressive behaviour caused by fear and/or anxiety.
15. The policy defines chemical restraint as a drug or medication used to manage a patient’s extremely violent or aggressive behaviour. If necessary, it can be used against the patient’s wishes. Chemical restraint may be needed in the situation of a sudden acute incident or aggressive situation or to maintain patient safety on an ongoing basis.
16. The policy says physical restraint must be used for the minimum amount of time and with the minimum amount of force. The carer must reasonably believe that it is necessary to act in order to prevent harm and it is equal to the chance of the patient suffering harm and the seriousness of that harm.
17. The medical records show that two staff members documented an incident concerning Mr A and a hospital porter. The notes record that Mr A shouted aggressively as a hospital porter transferred another patient into the ward. Mr A continued to be verbally aggressive after the porter offered reassurance and attempted to walk Mr A back to his chair.
18. The staff statements record that Mr A threatened the porter with physical violence and staff called for security assistance. Two statements say Mr A spat at staff and physically assaulted the porter. Three security porters restrained Mr A in his chair and then moved him to his bed.
19. One staff member attempted verbal de-escalation, but Mr A would not engage and continued to be verbally abusive and threatening towards staff.
20. At 8.24pm, staff sedated Mr A with an intramuscular (IM) injection of lorazepam (medication used to treat agitation).
21. At 10.10pm, a doctor reviewed Mr A for a possible cause for any acute confusion or agitation since the incident. Mr A reported new pain on the left side of his chest and a new headache. The notes record Mr A was able to lie flat on the bed for examination and able to move without significant pain. They also record Mr A did not appear confused and seemed to have a good understanding of the incident. The doctor requested a CT head scan.
22. On 10 February, staff contacted the mental health team to discuss the incident. The mental health team declined to review Mr A because he was known to a community team and there was no need to see him acutely.
23. The records also show Mr A recalled the incident clearly but provided a different story. Mr A recalled the hospital porter repeatedly punched him in the face before security porters pressed and punched his sore chest. The records show Mr A had no obvious facial injury and his CT head scan was unchanged.
24. In the evening of 10 February, a staff nurse recorded Mr A’s verbally abusive comments about several staff members involved in the incident.
25. In response to the incident, two staff members completed incident detail reports overnight between 9 and 10 February about Mr A’s verbal abuse and physical assault towards a staff member.
26. The Trust held an internal patient safety incident panel on 30 March. The record of the meeting included the three statements, a list of attendees, physical and psychological impact grading, agreed management, and an overview of the discussion.
27. In this case, Mr A is recorded as shouting aggressively at a hospital porter. The porter attempted to de-escalate the situation by offering reassurance and trying to return Mr A to his chair. Unfortunately, Mr A continued to show verbal aggression and threatened the porter with physical violence.
28. We understand Mr A recalls that the security porters punched him in the face. We have found no other evidence to support Mr A’s account.
29. We can see doctors physically examined Mr A shortly after the incident on 9 February and again on 10 February. These examinations document signs of injury to Mr A’s chest but state there was no sign of injury to his face or head. We have also considered the fact that Mr A’s CT head scan showed no changes from his last scan.
30. Mr A’s mother told us about a similar episode Mr A had in December 2022 at another hospital. She provided a copy of the relevant medical record which showed Mr A was verbally aggressive to staff. She told us staff had been trained to manage similar situations without physically restraining Mr A. We are grateful to Ms A for sharing this with us.
31. On 9 February, the records show Mr A had not calmed down when staff attempted to de-escalate the situation and he physically assaulted a staff member. This is different to Mr A’s behaviour at the other hospital. The records Mr A’s mother showed to us suggest Mr A had calmed down during the incident in December 2022 and had not assaulted any staff.
32. Security staff at the Trust physically restrained Mr A when they attended the ward. This is in line with the Trust’s policy that states the aim of any restraint is to maintain the safety of staff by attempting to control the aggressive behaviour.
33. And, the Trust’s policy states carers must reasonably believe it is necessary to act to prevent harm. In this case, the records show Mr A spat at and assaulted a staff member. The staff followed the Trust’s policy by physically restraining him, as this prevented further harm from happening.
34. The policy also states the use of physical restraint must be applied for the minimum amount of time and force. The statement taken from the security manager said security staff were on the ward for 30 minutes. The medical records show security staff were on site before 8.30pm and that staff were able to record the incident at 9.10pm.
35. Due to the heated situation, staff were unable to remember exactly when the situation happened. This means we would not be able to take a view on how long staff used physical restraint for. But, the records show staff only began to physically restrain Mr A after his assault of a porter and not before. This is in line with the Trust’s policy.
36. Mr A’s mother also raised concerns that the Trust chemically restrained him. The records show staff sedated Mr A with lorazepam because he continued to be verbally aggressive and threatened violence towards staff. This is despite two attempts to verbally de-escalate the situation by the first porter and nursing staff. This is in line with the Trust’s policy that says medication can be given, even against the person’s wishes, to manage a patient’s extremely violent or aggressive behaviour.
37. We understand it must be frightening in the situation to not know what medication is being given, especially when you are as emotional as Mr A was at the time. We hope this explanation has reassured Mr A that the chemical restraint was in line with Trust’s policy and was used as a last resort when other methods to de-escalate the situation had failed.
38. We have carefully considered the evidence provided to us and reviewed the relevant Trust policies. Based on this, we have not seen any signs that anything went wrong and we have decided not to take any further action.
39. We appreciate this complaint has come to us under distressing circumstances for Mr A. We do not wish to take away from what he and his mother have told us about his experience. We would like to thank Mr A for raising his concerns with us and hope our explanation has provided some reassurance that the Trust acted in line with local guidelines.