Transition from restraint to restraint free facility

  1. Working in a LTAC (Long term acute care) facility has pros and cons. We are currently looking at attempting to go restraint free! The research has been studied and the laws have been read. What I want to know is what are y'all doing for ventilator patients that CAN NOT be sedated? Most of our patients are admitted straight from other CCU/ICU facilities, with LOS about 25 days. Suggestions, PLEASE!!!!
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  2. 21 Comments

  3. by   nilepoc
    hmmmm, make sure their trach ties are tight and that the vent connection is loose and listen for the alarm.

    This sounds like a nutso policy to me.

    Can't you at least use propofol?

    And why can't you sedate them?
  4. by   mercykitten
    We (hospital) have been told to go restraint free. While I understand the intentions behind this, the reality is that it doesn't work. First of all, it does not support patient safety. We had one pt. fall four times in an hour, one time with the nurse standing right there. It is also an issue of patient safety for others....pts can wander into another's room.....and can become hostile and combative.
    Secondly, we don't have the staff to handle this. One night we had to have one RN stay with one patient. We're just a regular floor with telemetry....our RNs have up to six pts plus must help their LPN buddies. One night the same team had this psych pt and another pt with a heartrate in the 30s....but pysch pt was combative.....Fortunately the other pts's heart rate went back up. But there was a potential for that one pt to keep another pt from getting the prompt medical attention that was needed.
    I think that restraint free policy while well meaning, is against all common sense. Unless of course, we are trying to cut short people's lifespan by having them fall and break their hips. And while the nurse is doing this restraint free policy, who is going to be liable when the pt. falls?......We all know that it will be us.
  5. by   Ric
    LTAC's can not use conscious sedation per hospital mandate. Of course, JACHO does give us an out to use restraints. Assessment, reassessment, reassessment, reassessment, reassessment, and on and on...This issue will be the last one addressed by our facility. Policies are being reviewed in an attempt to prioritize the patient's safety and lead, in a prioritized manner, to the ultimate conclusion that restraints are the best way to ensure the safety of the patient. The problem is that it's kinda hard to come up with "alternatives" for vent patients! Along with this we are going to a modified team nursing practice with a staffing matrix increase! I may have to pull a team member for these patients. Don't want to but I may have no choice.
  6. by   Cubby
    Originally posted by mercykitten
    We (hospital) have been told to go restraint free. While I understand the intentions behind this, the reality is that it doesn't work. First of all, it does not support patient safety. We had one pt. fall four times in an hour, one time with the nurse standing right there. It is also an issue of patient safety for others....pts can wander into another's room.....and can become hostile and combative.
    Secondly, we don't have the staff to handle this. One night we had to have one RN stay with one patient. We're just a regular floor with telemetry....our RNs have up to six pts plus must help their LPN buddies. One night the same team had this psych pt and another pt with a heartrate in the 30s....but pysch pt was combative.....Fortunately the other pts's heart rate went back up. But there was a potential for that one pt to keep another pt from getting the prompt medical attention that was needed.
    I think that restraint free policy while well meaning, is against all common sense. Unless of course, we are trying to cut short people's lifespan by having them fall and break their hips. And while the nurse is doing this restraint free policy, who is going to be liable when the pt. falls?......We all know that it will be us.
    I WANT TO KNOW HOW A PATIENT FELL WITH A NURSE RIGHT THERE? WHAT WERE THEY DOING? DOES NOT MAKE SENSE!!!
  7. by   Jenny P
    Increasing the staffing matrix is the best way to go restraint free. I work in CV-ICU and our staffing ratio is 1:1 or 1 nurse to 2 patients at the most. We try to keep all of our vented pts. 1:1 and rarely use restraints in our unit unless the pt. is confused and actively attempting to pull tubes out. We also use "sitters" to sit with the patient if the patient is confused and picky and we are short staffed. The sitter is at the bedside for a whole shift to make sure the pt. doesn't fall or pull on tubes. We also have a confusion bag that is full of stuff for confused patients to do to keep their hands busy-- balls of yarn, small hand balls, play-dough, zippers, pockets, etc.-anything that is safe for them to play with and keep their hands busy and out of mischief. Last night we had 6 confused patients but only one needed restraints-- and she REALLY wanted to pull her tube!
    I know that increased staffing is probably the one thing that won't be done in LTC, though; so I don't know what you can do about that.
  8. by   wildtime88
    Jenny you are right on the money.

    If you are to go restraint free, then you must have the staff to do it safely.
  9. by   Huganurse
    Happy Holidays!
    Last edit by Huganurse on Jun 30, '02
  10. by   DethOkay
    As a travling nurse I have seen a nursing home which uses floor mats beside the patients bed. if they fall from the bed and hit the mat its is not considered a fall..... the beds are very low to the ground but when i asked about injuries I was given a run arround answer....SO I cancled all my shifts there and told them I would find a job somewhere else.........
  11. by   Ric
    You did the right thing. According to JACHO, low beds are an alternative to restraints, BUT if the resident/patient falls onto the mats IT IS A REPORTABLE FALL. The mats are to help reduce the impact and hopefully prevent injury. Unfortunately, many patients want to retain as much control as they can, and low beds are great in helping patients that have low centers of gravity and have been found to reduce falls.
  12. by   daisymae
    Arizona hospitals have been trying to do the "restraint free" thing for several years. I worked in a rehab hospital when it first started. I think it was 96 or 97. Oh my ! Not enough staff to pick 'em up. We had all kinds of doo dads that were not called restraints. Like....the velcro belt that would have the opening toward the front. Well, yah, you guessed it. The wiley ones would get the belts open and fall out of their chair. Kind of reminded me of the little guy on the tiny tricycle from "Laugh-in". (Old show-dating myself) It's not gotten too much better since then. We do use restraints after we exhaust all other avenues. We look to families to sit first. Then we try to get a sitter. (We are supposed to be a sitter free hospital who management found out we can't do it without sitters) Well, duh ! We do use Vail beds sometimes. But we have some families who scream bloody murder if we put their loved one in a cage. I guess it's okay to tie 'em down.

    And yes..... It always comes back to us if we let them fall. "Where were you? Why didn't you prevent this." We also have experienced a cut in staff. 12 patients and 3 staff.

    My only response is .....WHO HAS THE WINNING LOTTERY TICKET. AND CAN I BUY INTO IT?
  13. by   tex
    gOOD TO HEAR from someone in Corpus Christi tex I was born and raised there.............I currently am a RN cordinator in North carolina.........tex
  14. by   mercykitten
    Thanks for your note, but I am in Kentucky.....I guess some of the info at allnurses.com got mixed up. But I do like both Texas and North Carolina. My twin brother went to Duke.....mercykitten.

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Transition from restraint to restraint free facility