Child psych patient restrictive interventions

[WantAccel.BSN, BSN, RN]

We've recently had some pretty major issues surrounding transporting violent children to seclusion. We've been instructed not to "carry" children, but it also seems equally harmful to hold them in the middle of the hallway or wherever it is that they stop walking (setting off other children watching, the child themselves being embarrassed later, etc.). On the adult units, we typically wheel the restraint bed to the person if go "dead weight" to avoid a carry, but we're not allowed to use mechanical restraints on the child unit. We've been told there is research that suggests mechanical restraints are traumatizing to children, but I can't imagine it is any more traumatizing then being held for an extended period of time by several adults.

What do other hospitals do with this?? We are in desperate need of suggestions! Even if you don't have a child unit at your hospital, do you have any ideas for us? Help!

[elkpark]

I worked for several years on a high-acutity, true tertiary care adolescent inpatient psych unit (we got kids from all over the Eastern US, kids who had been everywhere else and hadn't been helped, a "good" shift was when nobody got hurt ... :)). Lots of our kids had been sexually abused and, yes, it was retraumatizing for those kids to be strapped down, spread-eagled, on a bed when they needed to be restrained.

Do you recall "papoose boards" from your peds rotation? The little vinyl-covered boards with the broad flaps that they use to secure infants and toddlers for invasive procedures? Wraps 'em up like a little burrito? Turns out those come in a range of sizes, up to 6'/adult size. We had a few large papoose boards that we used to restrain the kids. The advantages were that we could easily carry the board to wherever the kid was going off, strap the kid into the board on the spot and then pick up the entire unit, restrained kid + board, and carry it easily to the seclusion room without the danger of "rassling" with a struggling kid all the way there, and, because the kids were entirely "swaddled" within the flaps of the papoose board, it was not retraumatizing the way regular restraints were and the kids actually felt safe and contained on the boards (instead of exposed and vulnerable, the way they did in traditional limb restraints) and appeared to calm down and regain control quicker than they did with traditional restraints. I really liked having them.

If you're just not allowed to use mechanical restraints at all, that wouldn't work for you, but if the issue is primarily the concern about limb restraints traumatizing kids (esp. those with a hx of sexual abuse), it might be an option.

Best wishes!

[littlek1627]

We have adolescent units (male & female), but we do actually use psychiatric restraints for them. I can't imagine anyone that would feel that its safer or better emotionally, for them to be held in the floor for lengthy periods instead of having them secured/safe/restrained in a private area until they are calm/regain control. We have 'Transport Boards' that we use to transport them from wherever they may lose control to the restraint room. These boards have Velcro wrist & ankle restraints on them as well. Bless you for having to work in an environment that does not allow you to do what is best for your young patients, as well as the staff!

[SwampCat, BSN]

I work with the under 12 group. In my facility we just get them into seclusion asap, even if that means two people escorting a child whose feet aren't even touching the floor. Legend has it that we used to use something like Elkpark burrito thing but it has since been scratched due to possible restriction of breathing. We have a restraint chair (with wheels) but are only supposed to use it if the kid's feet touch the foot base. I feel that thing is much less traumatizing (if there is a traumatization scale) than strapping a kid to a board, but many of my coworkers think it can end up being a liability. In your situation the restraint chair might be beneficial since you can get the kid in the chair wherever you need to and then wheel into seclusion.

[WantAccel.BSN, BSN, RN]

Thank you so much for the responses!! Would any of you be willing to PM me the name of your hospital and a good contact person? Management really wants to talk to another facility about specific devices, policies, etc. It would be exceptionally helpful if any of you were willing to share that information!

It's somewhat odd because they allow us to use a restraint bed on our adolescent unit, just not on our child unit. They also won't allow a "carry" because a child was dropped several years ago.

Thanks again for all the feedback. Any additional information anyone is willing to share would be amazing. At the end of the day, all we want is to do what is best and what is safest for patients and staff alike.

[SwampCat, BSN]

Our facility has been basing a lot of our changes on Butler Hospital (Providence, RI) 's methods. I'd start with their Director of Nursing