ETOH Safety

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I'm concerned about ETOH and safety.

I work in the critical care unit. I get patients that have sitters on the floor. When they come to CCU for alcohol withdrawl b/c it cannot be controlled without ativan gtt or they're too out of control we'll on the floor we'll get the patient.

We are a restraint free hospital as of a few weeks ago. When these patients arrive to our unit the sitter has to leave b/c managers tell us we're not allowed safety sits in the unit.

We always have another patient with a person going through DT's. DT patients are so unpredictable as we all know. I can have them uncontrol resting and all quiet not qualifying for any Ativan per CIWA and 5 minutes later the patients a safety risk to themselves.

How does your CCU/ICU help protect these patients?

Thanks for any input!!

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Specializes in ER, ICU cath lab, remote med.

I'm really interested to see replies to your quesion. I CANNOT understand how you're going to keep ANY confused critically ill pt safe without restraints or a sitter. A bed alarm might help if they're getting out of bed but what about preventing extubation, pulling foleys, ART lines, central lines, etc.?

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Specializes in LTC.

I don't understand why you can't have a safety sitter in the unit...its pretty common to have one....Has your NM explained her rationale on that one?

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I'm really interested to see replies to your quesion. I CANNOT understand how you're going to keep ANY confused critically ill pt safe without restraints or a sitter. A bed alarm might help if they're getting out of bed but what about preventing extubation, pulling foleys, ART lines, central lines, etc.?

I don't understand why you can't have a safety sitter in the unit...its pretty common to have one....Has your NM explained her rationale on that one?

o I know I know; pick me pick me!!!!:igtsyt:

unless those pts. become a 1:1 you won't; and it's that way so the unit can save a couple $$$ on sitter fees and so you never have to report to the state dept. when a restraint was used because it's a bit stressful on the mngr when they get audited; and so when stuporous, DTing, A&Ox1 pt. gets out of bed and meets the ground within moments (possible after becoming intimate with a table, or machine or IV pole on the way down) while your comatose DKA is taking a turn for the worst; well now mgmt. can blame you for this most unfortunate event.

How'd I do?

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We have no posey's in the hospital any longer. We do have wrist restraints for our vent patients.

Does anyone's ICU been without posey's and sitters with severe ETOH patients? From what I understand we're aiming for a restraint free hospital. That's all that was told to use for a year. They introduced bed alarms in that year. Without a notice to RN/Dr's they removed Poseys from our hospital.

We do have bed alarms. They work and go off we'll hear them and run to the room seeing the patient whobbly in a standing position as we go in the room we're saying "GEORGE sit back down in bed" By that time it's too late and they're on the floor or we get them back to bed and 1/2 the unit of RN's nearly have a MI in stress.

The patients wife came in I told her how he's been climbing out of bed and chair and said remind him if needed to stay in the chair. Well 2 minutes after she arrived and I told her that the mans standing again and the wife is just staring at him saying nothing. I retold the wife not to let him get up...she said oh he said he wanted to go back to bed.:uhoh21:

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Specializes in RN, BSN, CHDN.

Restraints and sitters are never used in the UK, before I came over to the US I had never heard of either.

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Specializes in Emergency.

SUX and Diprivan???

Seriously how do you keep weekly drunk guy in bed when you are caring for granny next door who is on the vent with pneumonia trying to die and its not her time yet?

My answer is every time I fill out an incident report and it asks for my suggestion for prevention I put down sitter. They get sick of seeing it or its on every incident report of every pt that falls they will get a clue or someone's attorney will. AND contrary to popular believe incident reports will end up in court. Its a pretty dumb plaintiffs lawyer who doesn't know they exist.

Rj

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Specializes in ER, IICU, PCU, PACU, EMS.
o I know I know; pick me pick me!!!!:igtsyt:

unless those pts. become a 1:1 you won't; and it's that way so the unit can save a couple $$$ on sitter fees and so you never have to report to the state dept. when a restraint was used because it's a bit stressful on the mngr when they get audited; and so when stuporous, DTing, A&Ox1 pt. gets out of bed and meets the ground within moments (possible after becoming intimate with a table, or machine or IV pole on the way down) while your comatose DKA is taking a turn for the worst; well now mgmt. can blame you for this most unfortunate event.

How'd I do?

You took the thoughts right out of my head!

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Restraints and sitters are never used in the UK, before I came over to the US I had never heard of either.

ok, so what are your thougths about this? Are we whiney babies or did you leave the UK thankful that you still had a license? Can you provide some helpful info. on how to manage 2 CC patients when one has the right to remain silent, just not the ability (borrowed from Ron White)? Were units designed differently? When you say restraints, does that include chemical? It seems like a no-win situation for the nurse, but maybe you have valuable advice?

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We consider these clients 1:1 and pay the OT to cover

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Specializes in Critical care, tele, Medical-Surgical.

At my hospital it is up the the RN assigned to the patient in collaboration with the charge nurse to determine staffing needs.

A patient coming to critical care with a sitter keeps the sitter until the RN determines a sitter is not needed.

Often the patient will be a 1:1 for unstable vital signs, complex family and visitor needs, or because of drips and such.

Sometimes we need the sitter so the RN can care for another patient.

We can and rarely do use restraints as a last resort.

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Specializes in RN, BSN, CHDN.
ok, so what are your thougths about this? Are we whiney babies or did you leave the UK thankful that you still had a license? Can you provide some helpful info. on how to manage 2 CC patients when one has the right to remain silent, just not the ability (borrowed from Ron White)? Were units designed differently? When you say restraints, does that include chemical? It seems like a no-win situation for the nurse, but maybe you have valuable advice?

Yes we did use chemical restraints when we had to but it wasn't a standing order. I have also known situations when we have nursed a pt on a matress on the floor!!! I kid you not especially when pts have been known to thrown themselves out of the bed. We all know side rails dont achieve much when that confused pt wants to climb and fall over the top.

Since being in this country I have only once initiated restraints and that was for a pt who was violent. I really dont know how we managed some of the patients to be truthful but we did, and I can honestly say never once was my licence on the line in 17years. AS an RN in the UK you spend a lot of time managing on your own with very limited staff, I have been in a situation where I was only one of 2 RN's on a floor with 24pts and 2 PCT's and normally more than confused pt's.

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