Resident became dysregulated on the unit after a disagreement and began to verbally assault a staff member and hit her head on the wall. The staff member attempted to diffuse the situation by physically blocking resident from head banging and, in the process, resident physically attacked staff member by hitting and scratching her. A physical hold was initiated to maintain a safe environment. While in the hold, resident continued to attempt to assault staff by scratching, kicking and biting. RN and staff attempted to deescalate resident, but resident continued to attempt to hit her head on the floor, bite at and scratch staff. Because of continued self-harm and aggressive behavior, an emergency medication was administered. No injuries resulted from restraint. There is a small scratch and erythema on forehead from hitting her head on the wall before the restraint. Will continue to monitor for any deviations from baseline. Resident was placed in paper scrubs. Assault and self-harm precautions with constant line of sight were initiated, and clinical will follow up to determine an appropriate end date for the precautions. Licensing Specialist: Kendra Rice.
