use of restraints

gwenith, BSN, RN · Jun 8, 2003

The leagility actually depends on where you are - it is commonly accepted here in QLD that restraints can be considered illegal as it can be considered "false imprisonment". The bottom line is again correct assessment that the pateint cannot make a rational decision at the time ( the patient could be removing lines becasue they want to leave) and that in removing the lines/tubes tehy are at risk to themselves. I have had patients. for various reasons sign themselves out and they have calmly and persistantly removed all interventions. Stopping someone like this would be false imprisonment.

There is nothing wrong with having the family help with restraint. Family involvement is a cultural issue as well as being dependant on the family dynamic.

pickledpepperRN · Jun 14, 2003

I agree with all the above. It is good when a family is willing and able to help their loved one.

BUT- I care for fresh open heart patients most nights. When they come back the anesthisia is still working. Many need restraints until extubated. I NEVER leave. Immediate family are allowed to stay as they are able.

Most patients are up in a chair eating breakfast by the time I go home. They don't even remember being agitated and restrained.

For the minority who need mechanical ventilation longer some do need restraints for days. We do Q 15 minute checks. I remove each restraint at least every two hours and do ROM. We try not to wake the patient up, but sometimes it must be done for repositioning and so on. You guys know what I mean!

Below is a cut and paste from California Code or Regulations:

TITLE 22. Social Security

Division 5. Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies

Chapter 1. General Acute Care Hospitals

Article 3. Basic Services

70213. Nursing Service Policies and Procedures.

performance in the delivery of patient care shall be established,

implemented, and updated as needed for each nursing unit, including

standards for the application of restraints. Standards shall include the

elements of competency validation for patient care personnel other than

registered nurses as set forth in Section 70016, and the elements of

competency validation for registered nurses as set forth in Section

70016.1. At least annually, patient care personnel shall receive a written

performance evaluation. The evaluation shall include, but is not limited to,

measuring individual performance against established competency

standards.

(d) Policies and procedures that require consistency and continuity in

patient care, incorporating the nursing process and the medical treatment

plan, shall be developed and implemented in cooperation with the medical

staff.

(e) Policies and procedures shall be developed and implemented which

establish mechanisms for rapid deployment of personnel when any labor

intensive event occurs which prevents nursing staff from providing

attention to all assigned patients, such as multiple admissions or

discharges, or an emergency health crisis.

And a link to the BRN advisories:

http://www.rn.ca.gov/policies/policies.htm#RN

2bPhD · Jul 11, 2003

Remove the restraint, put the bed rail down and walk your patient... even if they are fresh bypass surgery. Radical I know, but it works.

healingtouchRN · Jul 12, 2003

I noticed spacenurse is in California where staffing is better. I sometimes have 4 patients, assigned to me, in CCU (yup, this is alabama) & our staffing can be the pits. I would like to do Q15 mn checks but not likely unless its a fresh art line removal. I do what I can but I can't chart at the bedside, rooms too small of computers. My assignments are usually not the norm. It's usually two, but very often 2 vents with drips & the like, an IABP. We don't have techs or aides (whatever they are called this week) so I have to hang out & wait for help to turn & bathe.....nuff said. :confused:

helix · Jul 12, 2003

Oh, HealingTouch! How awful for you and your coworkers! How can you stand working under those conditions?

I am in Maryland and we have protocol for medical and behavioral restraints. They both have different legal requirements and paperwork that must be followed. We automatically restrain all of our intubated pts until they prove they can be trusted. We use propofol gtts and restraints, which I personally think is silly. How can you honestly fill in the flowsheet that you tried to unrestrain the pt and it was unsuccessful if they are sedated? If they are sedated, take off the restraints! Anyway...we have to document that we have asked family members to stay and assist and make them aware that if no one is able to stay it may become necessary to restrain the pt for their own safety. As to walking the fresh bypass, I disagree. Our pts are often much too weak to even dangle, much less stand while intubated!

I would like to also say that sometimes the ICU psychosis can be cured with a mix of pain relief, windows left open 24 hrs to give the brain natural light, and one good night of sleep.

healingtouchRN · Jul 13, 2003

I am used to working here, this & GA is what I know. NO don't take breaks except to pee & heat my sandwich. I don't trust being out of my dept except long enough to go get by unit of blood or run to pharmacy. We have restraint protocols as per per JCAHO, who is coming to us Monday, by the way ... & I still restrain those loosely on propofol, becauseI had a guy the other day who was maxed on propofol & getting over ride sedation & still bucking the ballon pump & vent! Then the pulmonary guy in the moring said "night nurses oversedate", I mean what does he want me to do, let him stand up? Geez, these people obviously don't have to wrestle these buckin broncos. It's tiresome, thanks for the empathy. It goes along way. :rolleyes:

SICUNIP · Aug 10, 2003

try not restraining our neuro patients. One minute sleeping like a baby with sedation, the next minute sitting straight up in bed, with restraints, trying to extubate themselves. We explain to our family members and the patient the necessity of the restraints. And i have had no problem with family members understanding the the importance. We have restricted visiting hours, so family members there to watch for 24 hours is not possible (unless under 18).

confused101 · Aug 11, 2003

I work on a SIMCU floor, but our speciality is open heart patients. I sometimes feel that I am working on a psych ward. We had close to 10 patients at one time go loco on us. It is a running thing to have restaints. We try everything in our power to not to do this, but sometimes after the 2nd, 3rd, or 4th IV (trust me I have seen it!) We have to do something. We have patient companions(aka sitters). They sit there are watch to make sure that they are ok and not urinating in the corner. It is sure a help!

glascow · Aug 11, 2003

healingtouchRN, We seem to be working under the same conditions. In Louisiana its the same as you describe.

Breaks are limited to peeing if you can find someone to watch your patient while you go. I've gone many a 12 hour shift without peeing. Sometimes we get to eat, usually it's a sandwich or someother finger food that we can eat while standing outside of our pts room.

It's often difficult to find someone to help us turn the pt when it's time to wash the back and change linen. I work ICU, and we usually take 2 pts, but more often we are getting to work and have 3 pts.

I use restraints as little as possible. Now that the MDs are ordering diprivan more often on the vent patients, we don't have as much of a need for restraints. Some docs have been ordering precedex lately, but I don't find it works as well as the diprivan. Bradycardia is a side effect I've seen often with the precedex.

healingtouchRN · Aug 11, 2003

I am there with ya !! I ahve not used precedex. Lots of dip though. I hate it...the air bubbles & it runs out soooo fast!!

Last nite I had two alcoholics: one who the MD's d/c'd her Librium!!! I cleaned her poopie diapers from her playing in it 4 times in the first 5 hours of my shift meanwhile the man I have had the last 4 days went into DT's....no one knew he drank until asked his wife what his habit was...she replies "oh at least a pint of whiskey a nite". The day nurse found him smoking while he still had an IABP!!! Loving son lit him up!!!! anyhoo, he ripped out IV"S all nite, before I could give him vitamin "A" (ativan!) I had to 4pt & vest him, he assaulted 2 RN's before I could chemically control him. Very bad nite. I hate to sound like a sexist, but we need more men to help us. I just physically am tired of handling these people, esp the 250#+ people, we just don't have 4 people that can stop & turn & clean up. I made an off hand comment about looking for another job this a.m....my staff got really upset ("don't leave us!") but I guess deep down, I know things are not going to change & I am getting physically tired. I have 2 of my nite nurses out on illness(back injuries). We only have 5 to staff the 7p-7a slot for the 7 days a week. I am just too tired to keep up. I do have 2 others jobs (PT) so I have a fun avenue as well. ciao!

mattsmom81 · Aug 28, 2003

I sure can relate Healingtouch!! The aggressive, angry abusive patients (and the secret substance abusers who 'surprise' us) are also on the rise in my unit also. We expect a litle 'anesthesia crazies' but the problems we see today have escalated from years past.

I've been hurt on the job twice and it is from dealing with combative, out of control patients whose doctors have refused to sedate. So...we get hurt. Nice eh?

'Specially luv those super human combatants who break even the leather restraints........

I resent being told by managers that our nursing skills alone should be enough to calm these crazy folks. Just goes to show too many managers have been away from the bedside too long.

glascow · Nov 15, 2003

Last month we had a patient die at our hospital, he was strangled from his posey vest.

The nurse who admitted the pt from ER was overwhelmed with 7 pts, this admit made her 8th patient. She made an admit note, placed him in a posey.

Her next entry in the chart is 4 hrs later, the patient was dead.

Needless to say, they have now discontinued the use of poseys at our facility, and all staff is required to attend a 2-hr inservice on use of restraints. This is on top of our already annual mandatory on restraints.

How awful is this?? I have heard the family is not going to pursue legal action.

The nurse caring for the pt recieved no counceling or support from the hospital. The hospital lawyer questioned her and wanted to know why she removed the restraint when she found him dead.