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
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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
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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
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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-
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tion increases the impact of certain psychiatric
medications. This should be considered in pre-
scribing medications.
sychiatric assessment should include a full as-
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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
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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
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