I recently moved to the southeast from the northeast and I am unsettled about the use of restraints in this area. I worked in 4 northeast hospitals and the only time I ever saw a patient in soft restraints was when they were intubated. We used bed alarms, sitters, etc, but never restraints on someone who was simply confused. I have now worked at two southeast hospitals and I am frankly shocked at the number of patients who are in wrist restraints and waist belts (which I did not even know existed) simply because they are confused or pulled out an IV. I have even been ordered to restrain patients pulling off BiPAP masks. Oof.
Anyway, something happened yesterday that really bothered me. I responded to a rapid call on medsurg for a young adult woman who was “seizing”. Her seizures were extremely atypical and as someone who worked ED for 7 years, I suspected pseudo-seizures. This was confirmed when I transported her to the ICU and she spontaneously came out of her post-ictal period when the doctor mentioned intubation. During this whole episode, her IV’s kept becoming mysteriously dislodged and by the third, I realized she was doing it on purpose. When she pulled out the fourth, my nurse orientee actually caught her with her fingers around the tube and it was so well taped that she ripped the tubing in half. Once we were on to her she started pulling everything off, ripped out her 5th IV and got dressed. A hospitalist and a psychiatrist came to the room to see her and the psychiatrist determined and documented that she had capacity to leave AMA if she chose (she had a SO in the room who could drive her), but they convinced her to stay. She was also seen by neurology and had another “seizure” during the exam and the neurologist agreed that this was psychogenic. Another IV was placed and the intensivist ordered me to place her in soft wrist restraints so she would not pull another IV. I refused. He said that “interference with a medical device” was a valid reason for restraining a patient. So here’s my question. Am I wrong? Do I have a right to restrain an alert, oriented, adult woman who is not hurting me, not hurting herself, but simply allowing us to start multiple IV’s only to pull them out?
Pulling out medical devices is actually a reason to restrain someone. It’s one of the choices when the order is placed. I work in the ICU and we use a lot of restraints.
I personally would have let her sign out AMA. If she was pulling out that many IVs and stating she wants to leave, and you state she is in her right mind, I bring them the paperwork. You don’t need a physician to OK that.
*for a confused patient. Not a competent patient who's been deemed by psych to be capable of making decisions and who isn't showing a mental status change in the meantime.
Sometimes I've seen "lifesaving" medical devices and at my hospitals simply pulling out an IV was not a restraint indicator (unless the IV was a lifesaving medication like cardiac meds).
If her seizures aren't real, why are they keeping her? Why did they fight so much against her AMA? Does she have other medical reasons to stay? Also, may want to figure out why she is there - what does she want?
With the pseudoseizures and secretly pulling out the IV so she requires another it sounds like she's in it for the secondary benefits. But also wants to go so....
HiddencatBSN, BSN
594 Posts
*for a confused patient. Not a competent patient who's been deemed by psych to be capable of making decisions and who isn't showing a mental status change in the meantime.