Family members demanding restraints

[Rhonda12]

Last week I had an 88 yr old male with diagnosed dementia come in for an elective surgery. Of course he was a fidgeter and so I was doing my best to hide his IV and foley tubes as well as gave him some washclothes to fidget with. In addition, I was using a bed alarm (chair alarm when he was up) and eventually we put a video sitter on him (video monitor who contacts nursing via vocera PRN). There was no one to sit with him so I was doing what I could.

His family members were upset with me because: I wouldn't let them have all four bed rails up, I wouldn't "tie him to the bed," nor would I "just give him something to knock him out." I tried repeatedly to get them to understand that I legally could not do the things they were asking. They kept insisting he get something so he wasn't so agitated--I didn't think he was agitated at all, just fidgeting in my opinion. He was oriented to himself, calm and followed directions. I tried to explain to family how delerium works and why we didn't want to use additional medicines unless absolutely necessary. (The hospitalist did prescribe Zyprexa PRN for extreme agitation and directed me not to use it unless I absolutely had to.) The family left after telling me it would be all my fault if he pulled out his foley because I wouldn't "do anything."

Short of explaining the safety and legal implications, is there anything else you would say to this type of family member? I did offer to have the doctor come talk to them which they didn't want. I wonder how they handle him at home on a regular basis.

[Davey Do]

Great work!

Short of considering an order for soft restraints, I do believe you acted prudently and did the best job you could , TKKSN.

[NightNerd, MSN, RN]

I think you did a great job! Many of us can be a little too quick to rely on more extreme measures to keep our patients safe, so I commend the efforts you made to keep this man occupied.

I feel like I can interpret your description of the man's behavior in a couple different ways. Fidgeting is one thing, especially when the patient can be distracted by a busy blanket or something. However, it sounds like maybe he was also agitated to the point where he attempted to get out of bed unassisted, and possibly was working past some of the other safeguards to keep him away from his IV and Foley. I still think your explanation absolutely holds water, but especially if his behavior was becoming unsafe and/or if he was starting to lose sleep by not being able to settle, maybe you could justify the PRN, especially if it was po. That's the only thing that sticks out to me as a possible alternative.

It's a shame the family was not more appreciative of your care, because it sounds like you were wonderful with this patient. I wish my patients' families would ask me to sedate them! (Kidding! Mostly.)

[iluvivt, BSN, RN]

Please tell me more about how vocera can be used in that manner..We can put all side rails up if the patient or family signs a release form

[amoLucia]

OP - you must work hospital, right? If you were in LTC/NH, I doubt you would have had any order for a PRN antipsychotic.

Sounds like you did as well as you could short of having a nsg supervisor talk with them in order to back you up.

I have my own ideas about HOW the family is managing his behaviors at home. They seem to be TOO, TOO overly desirous of 'physical and/or chemical restraints'.

I pity any facility that accepts him as a LTC resident because the family will likely be a BIG problem.

[Nurse SMS, MSN, RN]

You did fantastic. I was always very blunt with the family in these situations. "We have specific legal criteria that have to be met in order to do what you are asking. He doesn't meet those criteria at this time. If we do what you are asking, then we are committing assault and can be prosecuted for that, which we are not willing to do. If his status changes, we will let you know; until then, we will continue on as we are. He is actually doing really well and seems calm at this time."

[Nurse SMS, MSN, RN]

You did fantastic. I was always very blunt with the family in these situations. "We have specific legal criteria that have to be met in order to do what you are asking. He doesn't meet those criteria at this time. If we do what you are asking, then we are committing assault and can be prosecuted for that, which we are not willing to do. If his status changes, we will let you know; until then, we will continue on as we are. He is actually doing really well and seems calm at this time."

Once the family was informed what they were asking met the criteria for a criminal act, some might have muttered a bit but let it go. I always stress with the families to control what we can.....the definition and legality of physical and chemical bondage is not something we get to control without a court of law changing the definition. Most people understand we aren't willing to break the law for them. Those who don't understand that have greater problems needing social support than just putting Mr. Jones in restraints.

[canoehead, BSN, RN]

You can do your teaching, but add that the decision is not yours, or theirs. It's a legal and medical decision, so if they still want restraints after the teaching you've supplied, they need to speak with the patient's physician and POA.

[lovingtheunloved, ASN, RN]

What else can you do? Roll your eyes and move on with your life. People are nuts.