Do you have this new protocol??

sharann, BSN, RN · Jan 19, 2002

Our hospital is "Restraint Free". If we need restraints, even in E.R. or ICU or PACU we need to call the SUpervisor and get them to bring us a set of restraints! I guess that until they arrive we have to sit on the patients to gently remind them not to kill us or themselves. I'm not sure how the renewals go. I think it is Q12 hrs or 24 hrs.

thisnurse · Jan 19, 2002

who is deciding these restraint protocols?

i thought they were all about safety.

amy · Jan 19, 2002

We actually got a memo that states we cannot hold a patient, whether it be with restraints or not, whether the patient is suicidal, homicidal, drunk or whatever, until a physician (and not a pa) has examined the patient and signed 939 paperwork. If that patient has expresses a wish not to be treated or is refusing treatment that that person's civil rights are being violated if we treat them. My department supervisors state that they do not agree with this DOH requirement. My question is, what do we do in the meantime? Let the patient run (hopefully not injuring anyone along their way), get a pickup order for the pd to execute, bring 'em in, let 'em run, indefinately until the doc is sitting on the doorstep with pen poised above the 939 form? Seems silly to me that the psych on-call staff has not been sent this memo. What about the patient that comes in in PD custody that is actively manic, hallucinating, or otherwise out of control or is even REQUESTING treatment but refusing a shot of good ole vits A+H? Maybe I am overreacting, but seems like a damned if you do, damned if you don't situation for the nurse involved! Any thoughts?

Jenny P · Jan 19, 2002

JCAHO came out with some new regs last spring or summer that threw our hospital in a tizzy and I posted a thread at that time (which I can't find--maybe I'm doing something wrong) about it. I imagine that as each facility is being audited by them the rules on restraints will be changed and tightened. We were first told that a MD HAD TO SEE and assess the pt. BEFORE restraints could be put on, and the doc had to renew the restraint orders every 24 (or was it 8 or 12?-- I forgot) hrs. I wrote my congressmen, and the hospital pleaded its case and the rule here is we can apply the restraints and the docs have to reorder restraints and see the pt. each day. It's not perfect, but it's a lot more tolerable now.

Askateer, that sounds like total overkill.

Amy, the DOH had nothing to do with restraints in our case; maybe you should recheck who the facility is blaming this on.

Home Health Columnist / Guide · Jan 19, 2002

Ponder these viewpoints...

JCAHO's viewpoint:

A clinical protocol places a restraint in the context of a larger series of clinical care processes used for specific non-behavioral health conditions and residents/patients. Restraint is not a clinical care treatment option. Restraint represents the failure of all other clinical care options and alternatives.

http://www.jcaho.org/standard/clarif/tx_restprot.html

Residents or House Staff writing Orders

for Restraint of Seclusion

http://www.jcaho.org/standard/clarif/tx_reseclusion.html

Preventing Restraint Deaths

Issue Eight November 18, 1998

http://www.jcaho.org/ptsafety_frm.html

Joint Commission Resources Publishes Restraint And Seclusion: Complying With Joint Commission Standards

Abstract:

http://www.jcaho.org/news/nb353.html

Alternatives to Restraints: What Patients and Caregivers Should Know

Home Healthcare Nurse

June 2000

Volume 18, Number 6

http://www.nursingcenter.com/ce/test/article.cfm?id=59A8908D-485A-11D4-83DE-00508B605149

Restraint-Free Care: Is It Possible?

AJN, American Journal of Nursing

October 1999

Volume 99, Number 10

http://www.nursingcenter.com/ce/test/article.cfm?id=1F5A52BB-9753-11D3-83EE-00805F9F34D3

Article Search re restraints, over 50 listed...

http://www.nursingcenter.com/mync/browse.cfm?keyTerm=restraints&new=true

thisnurse · Jan 19, 2002

i just went through the whole legality of restraint issue the other night with my manic patient.

i wanted him sedated...chemically restrained. so did his wife. she knew the potential for danger. this man was not himself, there was no way to judge what he was going to do next.

there was a definate potential for violence. i told the doc i was not willing to jepordize my safety for this patient.

the patient wanted to leave. we could not allow him to leave since he also had a new onset seizure disorder. but we couldnt 302 him either. psych wouldnt take him since he had a medical condition.

docs wouldnt restrain him cos they were oncall and not primary and there were implications for charges of imprisonment.

everyones disregard for MY safety really pissed me off and i let them know.they were all so concerned for HIS rights but not mine. i refused to comprimise my safety and finally they had security stay with him all night.

all of these restraint policies put us and the patients in one hell of a position.

deespoohbear · Jan 20, 2002

I can imagine the docs giving me an earful if I called them every 4 hours!! They wouldn't be to happy, that is for sure. Not to mention an unhappy nursing staff. Our policy on med/surg is a restraint order has to be ordered every 24 hours and the reason for the restraint. This has worked pretty well for us so far. It is something the doctor can live with and the nurse can remember to get done daily. We have a separate physician's order sheet for restraints, so usually the unit secretary on the evening shift puts a new order sheet in the chart every evening. You can bet though if my safety or other people's safety and well being was at risk from out of control pt I would restrain them and deal with the consequences later. And people wonder why there is a nursing shortage? :confused:

mustangsheba · Jan 20, 2002

You can bet requiring new orders q.4h will lead to a lot of documentation without substance. Most places require new orders every 24 hours. Some require documentation that the restraints are checked q. 1/2 hr. I personally prefer chemical restraints and feel we should have air hypos to administer the meds with standing orders for something short acting like Fentanyl. When someone is out of control, they needed to be prevented from hurting themselves and others. I think nurses fit into one of those categories. I will not put myself in harm's way. If a patient wants to leave and we don't have the numbers to safely restrain them, I will show them to the door and call Security and the PD. Unless they are homicidal, tying a patient to a bed is assaultive. We are responsible for our own safety. Don't do anything that makes you feel unsafe. That's the word from granny.

RyanRN · Jan 20, 2002

That q4 hour order sounds like it came from your DON - who sits in her/his office looking for things to do and ought to be hogtied and gagged - oops. I am sure JCAHO is satisified with q24 hour orders, thats the norm in New York and we follow our rules gosh darnit

We have a few nitwits, err I mean new docs who refuse to give us chemical restraints on many patients - and I quote "Oh no we cannot give Mrs.climbing-out-of-bed-ready-to-fall-and-break-her-other-hip 0.25 of Xanax, she is a COPD pt. and it might kill her". O don't think so! Same doc refused to sedate her when she finally had to be intubated because 'she gave us her very permission already, THEN he did a bronchcoscopy with NO SEDATION,same patient. I think she WILLED herself to die! Sometimes there is just no reasoning with buttwipes.

Nope, dont wonder for a moment why nurses are rushing out the door in droves and never looking back.

NurseDennie, BSN, RN · Jan 21, 2002

Q 4 hour ORDERS? In what world is that gonna happen?

Q24 hours hours is what's "legit." The orders have to be Signed by the doc, not a phone order. Q1 hour checks for skin/circulation problems, offer position changes, food/water/toileting. Q4 charting for the reasons for the need for restraint, what else you've tried, what else either didn't work or wasn't available, how the patient is tolerating it.

Love

Dennie

Trauma Columnist · Jan 21, 2002

I work in inner city trauma center. We certainly don't need an MD to decide for us how many times the pt gets to hit us!! That's insane! My safety is important too. Besides...I don't go to Walmart or Burger King or anyone else's place of employement and spit on them, hit them, assault them unless I'm willing to deal with the consequences.

In Illinois in Jan 2001, a new law took effect that makes it a felony to assault a healthcare worker, pre-hospital or in-hospital.

Our orders say renew q4hours, but I write an exception to this..."duration of ED stay" and the legal folks say that is okay.