have you used chemical restraint?

[diamondmeadows, BSN, RN]

Hello! :flowersfo

I am interested in hearing about your experiences with using chemical restraint in your practice. Have there been times when you have had a PRN order for Ativan, Haldol, or some other drug, and you used it to chemically restrain a patient? Researchers report that nurses state that they do so for many reasons, ranging from preventing patients from interfering with necessary treatments to keeping patients from wandering to quieting demanding patients when the unit is understaffed.

I am working on a presentation about this subject for my nursing ethics class, and I have been reading journal article after journal article. At this point, I feel that it would help to hear from some real nurses with real experience. I am expected to discuss pros and cons of this issue, so I would love to hear your thoughts, opinions, and personal stories about this subject whether you have used chemical restraint or not. With your permission, I would like to use some quotes for my presentation with absolutely no identifying data. I will not even say that it is from allnurses. If you don't want me to quote you, just say so! I still want to hear from you. Please feel free to PM me if you feel more comfortable doing so.

Thank you all!

[2shihtzus]

Yes, I have used them often...for patients who are agitated, aggressive, can't sleep, or anxious.

Am I the only one who cringes at the phrase "chemical restraints?"

[Virgo_RN, BSN, RN]

No, I have not used chemical restraints. I have, however, used medications to manage symptoms of the patients' illness. An example of that would be using Ativan to relieve the anxiety and tremors of a person undergoing ETOH withdrawal.

[2shihtzus]

What exactly is the definition of a "chemical restraint" anyways?

Alot of my patients are prescribed Ativan, Xanax, or Haldol for anxiety or agression. So just because I use those PRN orders, does that make it a "chemical restraint?"

[RNsRWe, ASN, RN]

I recall the definition of "chemical restraint" from nursing school as using a prescribed medication to keep a person from injuring himself or someone else.

Most of my patients have Ativan, Haldol, Xanax ordered as PRNs; the key there being that they ARE to be used if the patient has become agitated or anxious. If I see a patient becoming agitated such that they are more likely to injure themselves (or someone else), or interfere in their care--prevent the staff from providing necessary care, which in turn does injure them--then YES, of course I give that medication.

In effect, they are chemically restrained from doing harm, rather than physically restrained, the latter being typically less effective and more harmful physically and emotionally.

Give me Ativan any day over wrist restraints, if that option works for that patient.

If you're talking about using the PRNs when they are NOT indicated, simply to give the nurse the convenience of knocking the patient out for a few hours, then that's a different story.

[RNsRWe, ASN, RN]

One more afterthought: anyone who gives a medication that is not indicated (no agitation present, for example, yet gives 2mg of Ativan IV because of understaffing, as in your example) is not medicating that patient appropriately and IS unethical behaviour. Quite different from medicating someone appropriately based on their demonstrated symptoms.

[Tweety, BSN, RN]

I've often medicated a patient with prn medications like Haldol and Ativan to keep them calm when they are aggitated. Many times they are sick, going through DTs, injured, weak and if they get out of bed they will fall and hurt themselves, or they are so aggitated they are pulling out tubes, so I give the prn and use a bed alarm to keep this safe.

Is this "chemically restraining"?

[MaryAnn_RN]

Hello! :flowersfo

Researchers report that nurses state that they do so for many reasons, ranging from preventing patients from interfering with necessary treatments to keeping patients from wandering to quieting demanding patients when the unit is understaffed.

I have never seen sedation given because the unit was busy/understaffed. Wouldn't that be assault?

[Atheos]

I have never seen sedation given because the unit was busy/understaffed. Wouldn't that be assault?

Assault is just a threat. Verbal or any other form.

When there is actual physical contact it is Battery.

[ONCRN84]

I agree with everyone. If the demanding patient is alert and oriented, I wouldn't give them something.

But if the person is confused, unstable, trying to get out of bed, aggitated, confused, withdrawing, compromising their safety, compromising our safety, or compromising their care, you bet I'm giving them a PRN to knock them down a notch.

I'd rather give some thing PRN than restrain, but sometimes we'll do both. Give something so we're ABLE to restrain them, because when they wake up there's no telling what they'll do and if you're there to catch them.

(yes, I sent you a PM, but everyone elses answers convey what i was trying to say a lot better)

[racing-mom4, BSN, RN]

I would like to meet the nurse that has never used "chemical restraints" the hospital can be a stressful time for a patient, illness adds stress. If the Dr orders Ativan Prn/agitation by all means that is what he expects. Just like the Tylenol/Prn/Fever.

If I had an order for xannax and the nurse did NOT give it to me, I would be mad.

[KaroSnowQueen, RN]

Oh yes. This has been several years ago. We had a patient who was very big, not fat, just tall, stocky & muscular. He was completely delusional and would do weird things like urinate on the floor, and when asked what he was doing, would answer, "Why, I'm pi**ing on Jack Kennedy's grave, whaddya think I'm doing?" He usually was just funny, but sometimes he got mean.

One night he was going through other patients rooms looking for some unknown person. When the aide tried to redirect him, he shook her off like rain on a duck, and he went downhill from there. Got more angry, and tried to punch or kick anyone who came near him, staff, patients, even the furniture.

It took seven people, including two big burly guys to hold him still long enough to give him an injection. I was so afraid he would throw them all off and come after me!!!