Restraint without order
- 0I had a combative patient who was fighting off 3+ staff with enormous strength. She was a schizophrenic who had not been taking her meds. I paged the Dr to see if he would order restraints. He never called back. Eventually we had 5 people, three nurses and two aides in the room attempting to get her back to bed. We put restraints on and I called the Dr again, at home, to update the status. He ordered a med to calm her down, but didn't confirm the restraints order. I got the order scanned, administered the med, meanwhile the patient was getting out of the restraints and trying to pull at her tubes and scratch at staff. I called the Dr back again and asked him pointedly about the restraints. He ordered a higher dose of the med and was angry that restraints were used. No order. I administered the med dose he ordered and removed the restraints.
The patient calmed down and was subdued once the med was in her system. Now I'm terrified I'm going to lose my job, maybe even license over this. I have no doubt that the situation was extremely unsafe. Every person in that room was in danger, including the patient to herself. I tried to call for more staff to help subdue her, but we no one else was available in that hall. In the end all I can keep thinking is "I restrained a patient without orders".
Feeling like my career is over...
- 6Mar 11 by sapphire18 GuideIf placing a pt in "behavioral" restraints (as in this case), usually a dr must assess the pt face to face within 1 hour. If you took off the restraints when the dr refused to order them, you should be fine...that's one of those situations where you act first- maintain the safety of the pt and everyone else- and then get the orders the dr wants carried out. I've never had a dr refuse to order restraints before, but the good thing with the face-to-face assessment thing is that the dr will see with his or her own eyes how dangerous the situation is.
ETA: this is just how things have occurred in my experience. Other places may be different, policy-wise.
- 7Mar 11 by jrwestFirst off, the MD is a jerk. Was he there risking his safety with that psychotic pt ? NO.
I guess I wouldn't worry. No harm was done, and if it took 5 people to keep the pt and staff "safe", who can argue that restraints were a bad idea?
Did the MD( jerk) say he was writing you up? He can be angry all he wants.If he's not acting on it though, I wouldn't worry.
Ugh, seriously, what's his deal??why not no restraints, at least til pt is controlled.
Sorry you had to deal with this..
- 0The Dr is known to be difficult. Everyone at our facility rolls their eyes when they hear his name. It was 11pm and I was calling him at home. I also called the House Officer to come evaluate her face to face, which he did. But it was a resident and he said residents cannot write orders for restraints. The restraints were on for less than an hour. The attending DR didn't say anything about writing me up, but I filed an incident report and emailed my manager to let her know what happened. Now just waiting to see what happens.
- 3Mar 11 by Been there,done thatQuote from NursebirdyWhy on God's green earth would you write yourself up?The Dr is known to be difficult. Everyone at our facility rolls their eyes when they hear his name. It was 11pm and I was calling him at home. I also called the House Officer to come evaluate her face to face, which he did. But it was a resident and he said residents cannot write orders for restraints. The restraints were on for less than an hour. The attending DR didn't say anything about writing me up, but I filed an incident report and emailed my manager to let her know what happened. Now just waiting to see what happens.
Review your facilities policy , does it not say you have one hour to obtain the doctor's order and have the patient seen?
You could have mentioned the difficulty with Dr. Jerk and the resident "unable" to write a restraint order.
- 0I was shocked when he said that too. If you can't tell by now, I'm a new nurse, less than 6 months on the floor. I filed the report about it because the nursing supervisor told me to. She said her previous facility would give an hour to get orders, but I haven't been able to look up our policy from home. My coworkers who were helping me said they agreed with the need, but my boss sees things in black and white. I guess I can only wait and see what they do. Thanks for all the feedback, I appreciate it.
- 0Mar 11 by nurse2033I don't see a problem. You acted immediately for the safety of the patient and staff. Restraints need to be removed as soon as possible, and that is what you did. I assume you documented the patient's behavior and your requests for an order. This should be dealt with through your manager (who hopefully has a spine). A physician who disregards staff safety and won't back up a nurses judgement is an a**.