[achot chavi]

I am an ADON of a 200 bed SNF (LTC). When I started my new position I was horrified to see that 90% of the patients were restrained unnecessarily because my DON wanted zero falls and convinced the families of the wisdom of this. I tried working with the PT- instituting wedge cushions and they worked great. Five weeks in- one patient fell (didn't get hurt) and my DON pulled the project. I need ideas on how to reduce restraints safetly. Thanks

[BackInTheGame]

Ok this is going to sound horrible but there are times where I miss restraints. Not for my convenience but sometimes, they are needed for patient safety. We have a ZERO restraint policy and we get yelled at just for putting both siderails up on a bed. We've been able to reword some things, like lap buddy's being an assistive device (they're listed as restraints at our facility). One doc thought it was used to restrain someone until he saw the resident without it and realized that she constantly leaned forward in her chair and it really was necessary not only for her safety, but also for her comfort. Without it she leaned across her overbed table all day. I miss the days of being able to use a soft vest for someone in a chair. Instead we've become experts at the one second sprint across the unit to catch someone who thinks they can still stand unassisted. Had to send a pt to the ER the other night because her mind refuses to wrap around the fact that she needs help transferring. I agree that restraints, as a whole, should be avoided at all costs but sometimes they truly are necessary.

[Melina]

I don't have any experience in LTC other than my father's rather long stay in one. He had issues with falls, and the staff ended up giving him a mattress on the floor so they wouldn't have to keep him restrained. I don't know how feesible that would be at your place; it must have sucked for the CNAs who had to change bedding!

~Mel'

[BackInTheGame]

We have floor mats for fall prone residents when they're in bed. They're like larger versions of kindergarten mats so they fold up in thirds to make getting to the bed a lot easier... some times.

[achot chavi]

Thanks. I also think that the zero restraint policy is ridiculous. There obviously is a place for restraints to ensure proper sitting and safety for patients who really need them.
I was referring to patients who sit straight, are well-balanced and in general don't fall.
We also have a catch 22 as the restraint causes the patient to be agitated (and try to remove it) and then the nurses ask for meds to calm the patient down and guess what -before you know it the patient loses the ability to sit independantly!!

[weirdRN]

There are a lot of laws that have been passed b/c at some point someone decided that in LTC and in Psych facilities the restraints were being abused. I think a more reasonable view of restraints is called for in LTC with confused residents who are prone to falls and other injuries caused by their age and conditions.
How to get that instituted under the current laws is the million dollar question.

[chadash]

I am not for zero restraints, just very limited restraints. The fact is, restraints pose there own safety problems. They never replace supervision.
That said, lap buddies are our friends. Again, keep the pt in view. A slider can hang themselves up!
Alarms are great. You do have to chase them alot, but that is better than a fall or a potential restraint injury.
This is just not an all or nothing situation. The caregivers and staff should determine what is best for the patient, and recommendations should be based on that: individual circumstances. Never for the convenience of the staff.

[chadash]

Originally Posted by chadash

I am not for zero restraints, just very limited restraints. The fact is, restraints pose there own safety problems. They never replace supervision.
That said, lap buddies are our friends. Again, keep the pt in view. A slider can hang themselves up!
Alarms are great. You do have to chase them alot, but that is better than a fall or a potential restraint injury.
This is just not an all or nothing situation. The caregivers and staff should determine what is best for the patient, and recommendations should be based on that: individual circumstances. Never for the convenience of the staff.

Ooops! grammar police! I meant "their"

[LPN1974]

Originally Posted by BackInTheGame

One doc thought it was used to restrain someone until he saw the resident without it and realized that she constantly leaned forward in her chair and it really was necessary not only for her safety, but also for her comfort. Without it she leaned across her overbed table all day.

I hope when I get old and in the NH that someone will have pity on me and help me to lay down on my bed instead of making me sit up in a chair all day or have to sit up straight with a thing in front of me or lean over an overbed table.

Could this be the reason that some patients might be trying to get out of their chairs? Ya think?

[weirdRN]

I think that some residents, no matter where you have them, just want to climb. Some of them do not realize that they can no longer walk on their own, and need assistance.