Perimeter Behavioral of the Ozarks / Woodridge of the Ozarks

Staff reported resident was refusing to return to classroom and began self-harming by scratching her arms. Resident was able to be verbally de-escalated and returned to classroom. No injury reported, just reddened area of skin. Resident on self-harm precautions.

Staff reported resident was scratching at her skin while under blanket. Staff retrieved blanket and redirected patient. No injury occurred as resident did not break open skin. Resident remains on self-harm precautions and will be extended.

Resident was self-harming and being verbally aggressive to staff. Staff tried to verbally de-escalate and physically block resident from self-harming. Resident in response tried to bite staff multiple times and hit staff with their noise canceling headphones (given to decrease stimulation). Resident had to be restrained for safety. Once resident was restrained they were able to calm down and de-escalate. Resident placed on assault and self-harm precautions.

Resident was self-harming with a small piece of plastic, it is not known where the resident obtained the plastic.

Staff reported that resident was picking at old self-harm scabs. Nurse was notified and able to de-escalate resident. Nurse provided basic first aid and covered areas. Resident remains on self-harm precautions.

Resident began self-harming by scratching arms, pulling out hair, and banging head against the wall, and was placed in multiple brief physical holds to maintain her safety. Resident would re-escalate almost immediately after being released from physical hold requiring continued further intervention to maintain safety. Resident received IM medication as ordered by the provider to assist in emotional regulation. Resident was able to regulate emotions and maintain a calm demeanor with safe behavior after several interventions and processing with staff. Because of the lengths of intervention required for regulation/stabilization, provider placed resident on a 1:1 observation status. She was moved out to the comfort room for 72hrs on a 1:1 status and was given paper scrubs.

Resident began scratching at their old self-harm wounds and was re-opening them. Staff tried to redirect and verbally de-escalate patient but was unsuccessful. Resident had to be restrained for safety from 15:41-15:45. Upon release patient was able to voice she would remain safe. Nurse provided basic first aid. Resident placed on self-harm precautions.

Resident became triggered due to another resident on the unit self-harming. Staff began verbally de-escalating this resident and eventually were able to get them to quit picking open their old wounds. Patient will remain on self-harm precautions.

Staff reported that patient was banging her head into the wall and scratching her left arm in multiple places with her fingernails. Nurse was called and staff attempted to process with patient. Patient refused to process and became verbally aggressive with staff. Resident had to be placed into a physical restraint for safety due to continued self-harm. Doctor notified and order was given for one time dose medication. Resident calmed down after administration of medication. Nurse provided basic first aid. Patient placed on self-harm precautions.

Staff reported they found resident in their room self-harming under their blanket instead of sleeping. Resident was self-harming with a crayon. Resident refused to process or accept by mouth medications from the nurse. Crayon was retrieved and resident placed on LOS constant and self-harm precautions.

Resident became upset and started pinching her arm in order to self-harm. Staff blocked her hands from arms and resident attempted to bite staff. While staff were trying to process with her, resident took her glasses off and broke off earpiece leaving a sharp piece exposed. Staff retrieved and took the piece off the unit before resident could self-harm with it. Resident then went down the hall way and started banging her head on the wall. Staff blocked this but resident continued to escalate and had to be restrained. Resident was eventually able to calm down and was able to be verbally de-escalated. Resident on self-harm precautions.

Resident was in the classroom when a teacher gave her a crayon to color with. Resident became upset and began rubbing the crayon on her skin making a red mark. Staff took the crayon and resident began scratching the area with her nails. Staff were able to verbally de-escalate with no further issues. Resident remains on self-harm precautions.

Resident became upset because of comments made by another peer. Resident went to the end of the hallway and began trying to self-harm. Staff verbally de-escalated resident. Resident successfully pulled off a previous scab. No other injury reported. Nurse provided basic first aid. Resident on self-harm precautions.

Staff was notified resident had been using a bendy pencil to self-harm with. Staff were able to retrieve the broken bendy pencil that patient had hidden in her scrub pants. Patient gave up the bendy pencil willingly after some processing with staff. Resident would not report where the pencil came from. Resident will remain on self-harm precautions until improved behaviors.

Resident was sitting in the dayroom under a blanket and staff noticed resident making scratching motions with her arms. When staff tried to process with resident she became non-verbal. Blanket was removed. Resident remains on suicide and self-harm precautions. She is now on restricted linens due to continued threats of use for strangulation and using them to hide her self harming.

Staff reported resident was in the dayroom sitting next to staff when the lead technician came on the unit and confirmed this resident was on unit restrictions due to safety and previous behaviors. Resident got upset and start vigorously scratching her arms causing irritation. While staff was trying to redirect, resident got up and walked to the end of the hallway and staff saw that she had a crayon. Staff confiscated crayon and processed with resident and was able to de-escalate. Resident would not report where she got the crayon. Resident to continue self-harm precautions.

Resident used a crayon to attempt to self-harm on her forearm. Upon assessment, mild redness noted, with no breaks in the skin assessed. Resident placed on self-harm precautions with constant line of sight.

Resident began banging her head on unit door. Staff attempted to block head banging attempts, but resident continued. Resident was placed in a brief physical hold to maintain safety. After being released, resident became escalated a second time and began head banging in a secondary location on the unit. Resident was placed in a second physical hold to maintain safety. Resident received an IM medication to assist in regulation as ordered by MD. Resident was transitioned out of hold when she showed a calm demeanor and contracted for safety. No further incidents occurred. Mild redness noted on forehead by RN, no swelling or breaks in skin assessed. Resident placed on self-harm precautions with constant line of sight.

Staff reported resident went into bathroom and asked staff to close door while they were changing clothes. Staff refused due to patient being on Line of Sight precautions and also because they had taken a blanket in the bathroom with them and refused to give it to staff. Resident then became upset and began scratching leg with nails. Resident was able to be verbally de-escalated by staff. Resident on self-harm precautions.

Staff reported resident became upset with peers on the unit and began picking at old self-harm scabs. Resident irritated and re-opened some of them. Resident processed with staff and was able to be redirected. Nurse applied basic first aid to area. Resident to remain on self-harm precautions until they can contract for safety.

Staff reported resident demanded a specific staff talk to them and that staff was unavailable so resident became upset and began to bang their head on the wall. Resident continued to escalate and started to scratch at their arms and make them bleed. Staff was able to verbally de-escalate resident. Staff reported patient made suicidal comments during de-escalation. Patient on Suicide and self-harm precautions.

Staff reported resident grabbed another residents sweatshirt and began making comments that made them concerned about her safety. Nurse was called and sweatshirt was retrieved. While staff was verbally processing patient began picking at scabs on her arm. Staff were able to redirect and de-escalate patient with no further issues. Nurse applied basic first aid. Resident remains on self-harm precautions until she shows safe behaviors.

Patient became escalated due to another resident on the same unit. Staff were trying to process with patient and she reported that she has made several suicide attempts over the past few days. Upon investigation there is no evidence of this. Patient remains on Line of sight precautions. While staff were trying to process, patient grabbed a bendy pencil and attempted to self harm with it. She re-opened a previous scratch on her right leg with it. Staff were able to retrieve bendy pencil and eventually able to de-escalate resident. Patient placed on self-harm and suicide precautions.