Behavioral restraints and q15 min checks

[letina]

Just wanted to throw this out there to get some opinions. If you have a pt on behavioral restraints and therefore needing q15 min checks and documentation, is it reasonable to be expected to have a full pt load? Reason I ask is, I just had this happen to me. One of my patients was Baker Acted and behavioral restraints ordered part way through my shift. I also had an Oncology pt, a new admit s/p bowel resection, and 2 more med/surg patients and a new nurse who I was precepting. I had a tough time doing the q15 min checks as well as attending to the needs of my other patients. I didn't make a fuss, just did the best I could, but now I'm thinking I should have maybe voiced my concern. As it turned out, I eventually got everything done but had to stay 2 hours after the end of my shift to document everything and do an incident report on the Baker Act patient. But on reflection, I think it was pure luck that nothing adverse happened. So what do you all think? Am I over-reacting, or was this an unsafe situation?

[HM2VikingRN, RN]

I wouldn't have assumed that level of responsibility. A psych pt in restraints should always have a direct 1-1 staff with no other responsibilities attached.

I would never be responsible for a patient in restraints and have any other patient care responsibilities.

[TazziRN, RN]

I agree with Viking

[letina]

Thank you, that's what I wanted to hear. I've been thinking about if I should go talk to my NM and tell her I feel I should never have been expected to manage this particular situation, and now that you guys agree with me, that's just what I intend to do. OK, the event passed without incidence, but I don't ever want to be in that situation again.

It's strange, but sometimes we cope with things while they are happening, then when it's done we think "OMG how did I get through that?!!"

Never again

[southern rn]

At the very least you should have been provided a sitter to stay with the pt. Even though you are documenting q15 min checks, it is more or less a 1:1 with constant supervision.

[NicoleRN07, RN]

I work in a busy ED, but when we initiate behavioral restraints, that is an automatic 1:1. We never have a patient in behavioral restraints that doesn't have a sitter at the bedside at all times.

[Daytonite, BSN, RN]

i worked on a unit where we used to get patients in dts or for some other reason that sometimes needed restraint. i had a small timer that attached to my name tag that i could set for 15 minute intervals. i originally got it to remind me when my piggybacks needed to be flushed and disconnected (before iv pumps were used on all patients) and it came in handy for this as well. the reason you got the patient with the restraint checks was probably because you had an orientee with you and, by my count, a total of 5 patients (that's based on what you posted)--that orientee made an extra pair of hands. with an orientee by my side i would have made a plan to split up the restraint checks or the patient load between the two of us.

chances are this is going to come up again. as a nurse manager i would expect others on the staff, your co-workers, to help out with these restraint checks as well. that's only fair and is part of the teamwork we all owe each other as employees. part of the reason everyone listens to the shift report is to learn about these kinds of situations that are occurring on the unit. it doesn't take but a few seconds for anyone on the staff to look in and see if a patient is ok as one passes by their room. we used to keep the sheet where we marked that the restraint check was done by the door, so it was easy for any of us on the staff passing by to see if the patient needed looking in on.

if one's co-workers have no sympathy to lend a hand to help with this kind of situation i have to wonder:

why would the other people you work with leave you to flounder without offering any help at all at some point during the shift?

that might be a question you need to address. if there is no teamwork among my colleagues, i'd be mounting up and riding on to another job. i've always been willing to go an extra mile to help my fellow nurses out even when i'm busy too. that's just the right thing to do to keep good camaraderie. and, i never know when i'll be the one in need of another co-worker's kindness.

i'm kind of thinking that your major problem here may not be having to take care of a patient that needs q15minute restraint checks as much as it might be a bunch of colleagues that don't care about what is happening to any of the other nurses they work with. that's sad. and, i'm worried for your orientee who has now seen and experienced this. what must he/she think about how the people on your unit (don't)work together?

[SoxfanRN]

Every standard I have ever seen or read is to have 1:1 for behavioral restraints because of the very real possibility of death. Your 1:1 can be a sitter, CNA, MHW, or whatever, but someone should be watching them within arms' length at all times when in restraints. As an RN, as long as there is a 1:1, you can worry about q15min respirations/safety/circulation checks, q1-2 hour vital signs, every 2 hour ROM/BR/fluids. Anything less, I would refuse.

I would talk to your supervisor for yourself and your hospital. If a patient ever died in restraints, your hospital would get crushed in court because your are failing to follow standards of care.