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Instead, they exposed a juvenile psychiatric patient in a locked unit to unknown harm and subsequent trauma by using a weapon with the potential for deadly consequences. A. Brattleboro Retreat's Lack of Detailed Record Keeping Retreat records indicate, in general terms, that non-violent de-escalation techniques were employed unsuccessfully during the October 10, 2003 incident in response to A.N.'s agitated and threatening behavior. VP&A was unable to deduce from the records exactly what specific techniques, and to what extent such techniques were used. A.N.'s progress notes did indicate that attempts at redirection were used, i.e., ".asked to simply go to his room and not interfere in another patient's violence." and that a choice, specifically PRN medication, was offered to him. However, nowhere in the record was the type of "calming techniques" as recorded on the "SPECIAL PROCEDURES" form, described nor who attempted these techniques. With such a lack of detail, it is impossible for an independent oversight agency, or even for the Retreat itself, to objectively determine that staff's response to A.N.'s escalated behavior was optimal or compliant with their training before resorting to the police and use of a Taser weapon on this locked, juvenile inpatient psychiatric ward. It is apparent from the notes on the day of the Taser incident that A.N. was extremely agitated, verbally insulting to staff, and destroying property. The notes indicate that his behavior became increasingly more threatening once in the Quiet Room. The notes do not reflect, however, how he managed to get to the Quiet Room. The nurse's October 10, 2003 progress note simply states " r ; equiring quiet room" after A.N. had begun damaging furniture in his room and the unit hallway, while Dr. Knorr's progress note states ".and required a physical intervention. He eventually went to the Quiet Room." Again, without detailed records, it is difficult to ascertain what occurred prior to the explicit threats of harm to staff that A.N. began making once in the Quiet Room. In addition, there is no indication on the "SPECIAL PROCEDURES" form that any type of therapeutic hold or restraint was used at all on October 10, 2003, even though the progress notes and the Brattleboro Police Department records clearly state A.N. was restrained by staff after having been subdued with the Taser, in order to administer involuntary medication. The failure of the "SPECIAL PROCEDURES" form to indicate the use of any physical intervention prior to A.N.'s containment in the Quiet Room, as cited in Dr. Knorr's notes, as well as the utilization of a physical restraint directly following the Taser shooting, as cited in both the nursing notes and police records, demonstrates the need for improvement in the Retreat's recordkeeping. Similarly, no records were found indicating what, if any, staff consultation occurred resulting in the decision to call the police and who actually placed the call. The Retreat's "BEHAVIORAL EMERGENCIES" policy states that if a situation is determined to be too dangerous for staff to manage without additional support, ".the charge person may determine it is necessary to call the police." There is no indication that the Tyler 3 Unit charge nurse was the person who in fact made the determination that police intervention was needed or appropriate given the circumstances at the time. Additionally, A.N. and his parents report that not only are there discrepancies in their recollection of what was provided for information as well as what they observed on the unit, there was a lack of significant detail in some instances. The family noted that there were inaccuracies specific to some information reported in the records, such as how long A.N. had. Home steroid articles steroid profiles forum - discussion board breaking steroid news steroid books your ad here anabolic articles articles about anabolic steroids and bodybuilding steroid profiles anabolic drug profiles, with pictures and descriptions. The next adjusting for hours post cardura survey.
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