Transition from restraint to restraint free facility

mercykitten · Mar 15, 2002

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.

nursedawn67, LPN · Mar 15, 2002

I work in LTC, and we are restraint free. The only thing we use thaqt slightly resembles a restraint is a lap buddy. I still believe in the tie restraints, not for everyone but certain ones. We have a lady that no matter how many alarms we use she still gets up and falls out of her chair, the alarms don't work because by the time you hear it she is already down. They tried a lap buddy but she kept on removing it and same outcome....her on the floor. I don't believe in restraints for "convienence" of the staff, but for safety of the pt/res.

Donrn · Mar 12, 2003

I work in LTC and it is my understanding especially with a resdent who is on a Vent and coming off a 25 day LOS that you decrease po form sedation gradually to off. If this is not possible you do what is best for the safety (ABC's) of the resident. Ask other LTC facilities what they do. Also have a policy in place and try to work with the hospitals to wean off before coming to you. This way po drugs are in place upon arrival. Above all Care plan the attempted decreases. As long as you have tryed and have a diagnosis and MD progress note to support ,this DOH cannot touch it. Look holistically and have all disciplines involved. This is called Covering your Butt......Read your F-Tags if you need access go to CMS do a search and look up paper manuals. Then go to SOM chpter 7, f-tag 279 for care plans, f-tag 329 for residents sedatives and 309 for Quality care. Hope this helps.

itsme · Mar 12, 2003

We have to have a MD order for any kind of restraint, we have very few restraints. Not alot of falls, but we are told that the resident has "the right to fall". Side rails are considered a restraint if they are full rails, but 1/2 rails are not. We use alot of floor mats by the beds, and pt. alarms (tag alarms). So far so good, but we still have had the few broken hips.

ChainedChaosRN · Mar 12, 2003

We use alot of low bed with the bedside mats. A roll off of a low bed to a mat is considered a "fall". Any change in surfaces. That is not our policy...that is the current law, at least for LTC facilities.

There are some great alarms out there right now. One that I wish I could remember the name has a laser beam at the head to the foot of the bed..at the side of course. If the patient touches the beam, the alarm sounds. (Such as one leg going over the side of the bed).

TABS also makes an alarm that puts a mat under a resident if the weight is shifted a great deal, or when pressure is relieved it alarms.

For the extremely agitated I will put a mattress or two on the floor. Thankfully that has been rare.

Good_Queen_Bess · Apr 6, 2003

I work in neurosciences and with the best will in the world, if a patients wants to pull his trache out, there is nothing you can do to prevent them without restraining them. I'm not talking about tying someone to the bed, but just to "glove" their hands. Whoever wrote a "no-restraint" policy has never worked with a head injured patient.

We have strict restraint policies. This covers anything that could be considered a "restraint", from cot sides and locked units, to "gloved" hands. If a patient is restrained, it is documented.

What would you rather have? Someone pulling their trache out and possibly respiratory arresting or gloving a patient? Or someone pulling their arterial line out again, loosing more blood when they are already critically ill?

sassynurse78 · May 13, 2003

My facility is restraint free. It wasn't when I first started there, and we had a lot less injuries. But we are told the residents have a "right to fall" It is crazy! And I have had to put traches back in after being pulled out, same with I.V.s G-tubes F/C etc. I do not see the benefit to the person to have a trache put in two times a week, but this is the policy. And of course to go restraint free, the facility never increased staffing so you run yourself ragged chasing alarms. The worst thing is when you are asked why so and so fell, like you can prevent it or something.

gwenith, BSN, RN · May 13, 2003

A while back I was working in a facility that although they were using restrainets it was not on every patient. I was concerend that in our litigous secoiety we were going to leave ourselves open. I developed an assessment tool with the intention of researching it. Long story short - I left before I could research teh tool so here it is - I hope it helps someone or at least gives an idea of how to develop a "focussed assessment tool" for use in your faciility.

Assessment Tool 1

Level of Consciousness -

1. unconscious/ fully sedated

2. Fully orientated at all times

3. occasional periods of disorientation

4. disorientated

Level of Compliance

1. compliant and tolerant (never reaches toward tube)

2. occasionally reaches toward tube

3. frequently attempts to remove tube

4. determined to remove tube

Level of Activity

1. unmoving

2. moving only in relation to noxious stimuli

3. active

4. hyperactive

Security of tubing

1. well secured difficult to move

2. secured but may move with force

3. unable to secure fully

4 unable to secure

As I said it was my intention to use focus groups and action research to trial this but I never got the chance. I would be interested if anywhere else was using anything like this.

KaroSnowQueen, RN · May 14, 2003

I worked in an LTC that was restraint free and it was horrifying. State said they were adults and had the right to fall OOB if they wished. Okay. Then why does state also think we have to keep them in the bed with a ratio of one nurse, and two aides for 39 pts?

It didn't work, it couldn't work, it was crazy and one of the reasons I have LTC, I hope for good!!!

zambezi, BSN, RN · May 14, 2003

I am sorry, but the "right to fall"????Hello???I am sure that none of these patients have the intention of falling...but i guess if the patients wont stay in bed (or chair) a broken hip will keep them there...When I was in nursing school I was all for no restraing policys, but once i got into the real world...i understand the importance...I don't think patients should be restrained for convenience and of course, other methods should be attempted first but with todays short staffing and patients that can be a little nutty, it just isnt safe...and it is our license if the pt is hurt...i would love to see someone pulling this "right to fall" in court...I work in critical care at my hospital...when we have vented patients, they are restrained....everything is of course well documented...if we have a patient that has been on a vent for a few days and we are right there, the patient is our only patient, we will take the restraints off (like during bathing, etc...) but they are back on for our breaks, etc...it is just not worth pulling that et tube out because they are sedated and just want to grab for that tube in their throat ( I work post cardiac surgery so we try to extubate sooner than later)...restraints are a tough issues, no one should have to be restrained against their wishes, i wouldn't want to be....but....sometimes it has to be done for safety...just my two cents :)