Do you have this new protocol??

willie2001 · Jan 21, 2002

Our clinical nurse manager freaks at the mention of restraints. We are told that if someone is in restraint that they have to be constant 1:1 observation. If that is the case, then what is the point of restraint. We are led to beleive that this rule came down from JCAHO or HCFA, but I don't know for sure. I'm not sure but that she made up that rule herself. Of course the people who make up these rules don't know the first thing about caring for patients. Has anyone else heard of this 1:1 observation thing? :rolleyes:

Home Health Columnist / Guide · Jan 21, 2002

The reason for all these rules is because about 20 patients a year die while restrained. Check the links above.

RyanRN · Jan 21, 2002

TraumaRN how do the floors handle it after they are out of your care, we can't write any extension without threat of firing squad. I'm thinking the orders should be good for 24 hours . And,like you, I'll guard my life over breaking the 'rules' anyday, been lambasted many a time myself.

Willie, the only 1:1 needed in restraints, in NY, would be a full sheet, not wrists or what is called 'least restrictive'.

NRS, wonder how many patients were SAVED by being restrained, never mind staff! You think there are stats or studies on that?

Mijourney · Feb 1, 2002

Hi. Last recollection that I have of restraint protocol in a hospital was every 24 hours. I believe that we had to document the condition of the patient and response to restraints at least every hour or two. Restraint protocol also included controling and monitoring behavior with medications. Anyone familiar with this?

Agnus · Feb 1, 2002

In our hospital an RN can initiate restraint protocholes. The patient must be seen by an MD within I think it's 24 hours. (maby sooner my memory fails here) The oreder must be renewed by an MD Q24 hours. We just went through Joint Comission a couple of months ago and this was not criticized.

nurs4kids · Feb 2, 2002

Ours is Q4 on physical restraints. Most docs just tell you to write a new verbal Q4h. This was brought about by joint commission. We rarely use anything beyond elbow restraints, and these do not require a new order.

PhantomRN · Feb 2, 2002

At my hospital the protocol calls for a new restraint sheet to be signed by an MD Q24 hours. Pt checks are Q1 or 2 hour depending on if it is medical or psych,,,,,,however we only have to chart on it every 4 hours. This is in the unit, on th eregular floors of the hospital restraints are not allowed unless in an extreme case. And when someone is restrained on the floors they are made a 1:1..........stupid crap.

rondafan · Feb 2, 2002

In my facility you have to renew a chemical restraint q4, physical is q 24, the docs also have to lay eyes on the pt to use either one within 1hr of use. Luckily we're so small we have a doc in er 24/7. So I just wake him up. We had a non compliant schizo that was extremly aggressive & doc ordered thorazine IM but the pt was 6'3 250 lbs & didn't want to be touched, so we called the doc back. He was pissed he got woke up & said he'd just come do it himself. Well after the pt kicked him in his privates & we drug him out of harms way we got the pt transferred to a psych facility pronto. Now he trust our judgement. HA

PhantomRN · Feb 2, 2002

HAHAHAHAHAHAHA.....................Nothing like a little kick to the privates to wake some one up...........I would have paid to see that.........hahaha

deespoohbear · Feb 2, 2002

Just got into an arguement the other day with Occ Therapy and the use of a geri-chair with a tray for a pt. The OT was mad because we had this elderly, confusesd, just suffered a CVA lady in a geri chair with a tray. The night the nurse placed her in it was after she had climbed OOB 5 or 6 times, nearly fell twice, and wandered into several other patient's rooms. Tried a bed alarm, she just unclipped the clasp from her gown and placed the unit on the bed. OT freaked out at me the next day about the geri-chair. She said that is was the most restrictive restraint and what we were doing was illegal. I told her I have a valid, signed order from the physician and plenty of documentation. She wanted me to try a lap buddy and I told the patient would remove the lap buddy. The OT gal continued to get nasty, and I finally told her that I had nine other patients to watch and that if she wanted the pt out of the restraints that she could either set with her in her room, or take her to therapy with her! Well, of course she didn't volunteer to do either. I get so fed up with other disciplines telling me what is best for my patient and then turn around and go back to their own department where they are responsible for one or two patients at a time. :( Unless these other people are willing to practice what they preach, they need to back off!! Ughhh!! :(

RyanRN · Feb 2, 2002

Does the OT person work for JCAHO per diem? Sound like it, as they also haven't got the foggiest idea what bedside nurses have to deal with or how to solve the problem.

tylerrose · Apr 14, 2002

I work in trauma icu and most of our patients have head injuries due to mvc and most them +ETOH or drugs when they come in. Most of the time if they are intubated, we start them on diprivan but of course when we wean them off the vent, your diprivan is off, too. They maybe off the vent but if they have head injuries they are just all over their bed and there's not much one can do about it. To keep them from falling you just to restrain them, we use soft restraints and mittens, how they manage to get out of them, I don't know. Our restraint orders has to be signed by the MD q24h, you have to check and document the skin integrity q2h,

also document that all alternative to restraints have been tried before applying the restraints and this is driving everybody in the unit crazy and by the way the restraint order needs to be entered on the computer. We were told this is what DOH wants!