Shady S/R practices. . . - page 2

by BSNBritt 2,390 Views | 12 Comments

Hello all, I just accepted a job at a new psych facility, and so far it's pretty awful. Besides the nurses being completely rude and hostile to me all the time, there are some shady things going on with their seclusion and... Read More


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    I've been thinking about this and while I do work in psych (inpatient & acute/emergent), and I have seen patients in a combination of restraint/seclusion/PADS (the latter is a kind of restraint a pt can walk around in, but they don't have enough freedom of movement [theoretically] to assault someone - although I've seen it happen so nothing's perfect) but our documentation is really detailed. You have to have an observer, and q 15 min documentation, and a face to face with the ordering provider at least every 8 hours and check for ROM/need 2 pee/restraint fit very often; jeez, I mean it's really really detailed.

    I have seen really psychotic/violent/aggressive patients be in restraints and/or seclusion (and if you downgrade it to seclusion, then you have to get a new order to go back to restraints) for more than a day, and it was totally needed.

    But you are right, something about what you are seeing in the lack of detail in your facility says ominous things about patient safety.

    Diane
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    As a psych nurse, S/R is Code Blue. This is the most acute situation you can be in. Consider the crash team in the ED as the equivalent of the S/R situation on a psychiatric ward. There are many regulations in your state's Nurse Practice Act that deal with this situation. Every so many minutes a patient must be offered the opportunity to evacuate their bowel or bladder, to exercise a limb, circulation must be assessed, conditions for release must be communicated, opportunities for release must be documented, etc. All of your documentation will be reviewed by a board for abuse. S/R is extremely serious and every detail must be attended to without exception. It's a serious matter to take away a person's freedom of movement. Once you do so, your relationship with that patient is forever changed. How you implement your hospital's policies and your documentation of the same is vital to your continued employment and ability to therapeutically interact with the patient.

    It's easy to lose your license over S/R issues. Learn your hospital's policies and procedures, and adhere to them strongly. If you feel your hospital's S/R policies are out of line, get out.

    I know too many people who lost their livelihoods and their homes because of a serious interruption in their profession and credentials over S/R issues.

    A compassionate and professional implementation of S/R policies and procedures can enhance your relationship with a patient, if you can believe that. If a patient is a frequent flyer, they know what is supposed to be done. Meet their expectations and it's likely that you will be able to retain a professional relationship with the patient. That means fewer problems down the road with them.
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    Here is a link (doesn't seem to have been updated recently) that shows deaths of children 18 and younger at various types of psych facilities. Just horrible, makes my chest hurt to read this kind of stuff.
    http://www.caica.org/RESTRAINTS Death List.htm

    I know we have come a long way in psych tx, but COME ON!!! This is incomprehensible, deplorible, horrific...we have the technology to reach space, to explore the deepest parts of the ocean, we can even clone but the best we can come up with when dealing with someone who has a mental illness when all else seems to fail is to tie them down, sit on them and/or isolate them?! "I don't know what's going on here and I don't know how to fix it so I'll just tie it down, that'll work!" Unbelieveable...and people seem surprised when it doesn't work.

    I know why the majority of these tx's and these facilities do not work. Because they are based on profit, and you can't heal someone when the bottom line is what is considered most important. Well, that and how screwed up our society is, but that's a whole other argument.
    Last edit by Pets to People on Jun 14, '12 : Reason: added link


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