Hello,

I am a registered nurse who has recently taken a position at a long term care facility. My nursing experience has been in critical care in a hospital setting. I have been looking for written information regarding how often physicians have to renew physical restraint orders in the nursing home and who is responsible for having the patient sign consents for the administration of psychoactive drugs in the nursing home. If anyone has information regarding these inquiries I'd appreciate some feedback.

Thanks

In my experience:

Q 24 hours and the charge nurse. (Basically whatever nurse is there when the family POA etc come visit) Does your facility allow for verbal consent pending written? Good luck.

Restraints, I have no idea. I've only ever worked in "restraint free" facilities. Our beds don't even have siderails, just those tiny little hand grabby "positioners" literally only a handspan large (which will still need signed consent for...).

For the psychoactives, as the last poster said, whichever nurse has the patient when the POA family comes in gets those consents signed. Or if the patient signs for themself it's usually (hopefully) done right upon admission or as soon as the med is ordered.

In the hospital a restraint order has to be renewed every 24 hours for safety and every 4 hours for behavioral, but the nursing home I am working in has restraints as standing orders, which are reviewed every 3 months...so I wasn't sure if this was the standard in nursing homes.

What's considered a restraint in the nursing home these days?

Is there anywhere that belts or four points etc. are actually still used?

In my facility we can only use low beds, mats, and alarms up the yin. (We have pull, pressure and laser alarms).

the F-tag (LTC regs) manual explains that well..plus check your facility's policy. depending, there are lots of things that can be considered a restraint in ltc. so it would help to know what kind you are talking about and the reason for it. otherwise it is to only be very last resort, there has to be a trial of other attempts to not use restraint, then you get the physician order, consent signed by family/ or POA ..all of this is of course is reviewed with your interdiciplinary team, then you have to make sure the resident is removed from the restraint, offered activites, offered bathroom, offered hydration etc at least every two hours, then in long term care the restraint really doesn't have to be reviewed or have updated orders quarterly and as needed. as needed means, always look for opportunity to remove it if not needed, if there is a change in condition, etc. there are usually assessments that need done initially and quarterly and you have to prove you have tried attempts to d/c the restraint or not use it at all.

it really is a complicated issue especially if you are used to hospitals who have a more liberal restraint use policy...definetly look at the LTC regs, go to cms.gov that may help too...

hope this helps?