Hospital wants pts restained rather than pay for sitters

[DebRN06]

Well...I am yet again extremely disappointed by the "powers that be." I guess the hospital is over budget and has now decided getting rid of sitters is the way to save.

We are now supposed to call the family and tell them that 1) someone from the family needs to come and sit with the pt or 2) they can pay for a sitter and if neither of those then we will have to get an order to restrain the pt!!!

This started a couple weeks ago and there have been so many problems already, as any intelligent person would have realized. A secretary got bit by a pt because instead of having a sitter, the pt was put in a wheelchair and placed next to her at the RN station. One day we ended up with one tech on the floor with 30 pts because 2 were pulled to sit. There is more, but this will get too long!!

Everything about this is so wrong...#1, of course, is not treating people with the dignity and respect they deserve. I want the "powers that be" to bring in their confused parent and have them restrained. How quickly they would change their tune.

I am just so upset and disappointed. :angryfire

This is coming from the top...I don't know who to go to or what to do. My manager is part of the problem. She will do anything to save a dime.

Thank you for reading...any advice would be much appreciated!!!

[justme1972]

....this is just a family perspective here, as I'm a student.

I had an aunt that had to undergo restriants about four years ago. She was a heart patient and her bypass surgery did not go well, and there was a period of time when she was on a ventilator and kept trying to pull the tube out, and we showed up to find her in wrist restraints one day, and it's a disturbing thing to see if you have never seen it before.

She remained in acute care for about 2 1/2 months.

Now, we are a large family, and I am one of the very few that was not a medical professional...so all of us understood why it was necessary. My aunt had no children and was widowed, and since I lived the closest and had no kids myself at the time....I was the one that attended to her during visitation hours the most.

The most tragic part, as a family member, is that the communication ability of the patient is completely taken away if they are also on a ventilator. My aunt (who was a retired RN) wrote several times (on a pad) that she feared greatly about aspirating and choking to death and no one noticing unless she coded....because she had witnessed it before. She was very lucid at times and all-too-aware of what was going on.

I came to the hospital once to find tears streaming down her eyes. There was a nurse that had been on her shift for almost two hours...each RN had only two patients.

I asked the RN what was wrong with her, and she said, "Oh, they get pretty emotional at times."

I gave her a pen and pad, unwrapped a wrist and said, "What's wrong" she said, to my horror, that her back was itching...and had been for most of the day, and she felt like an army of ants were crawling on her back and biting her. She couldn't tell anyone!

I showed this to the RN and got, "I'll get to it in a few minutes." I said, "No, you won't, you need to take care of it now or find someone who can." I was furious! I said, "Have you ASKED her if she is in any pain since you have been here?" I didn't get a response.

Well, they sat her up slightly, and her entire back was covered in what appeared to be a severe heat rash...I took a comb and took it up and down her back to relieve the itching...my aunt nodded that it was bringing relief, and then we put baby powder very heavily on her back and it was repeated when she was being bathed from then on out.

This was at a top facility where I live...and this was the "attitude" that I got from several of the staff. I thought it was horrible.

It sounds silly...but something as simple as an itch can drive you mad, and I can only imagine the host of discomforts that a patient can suffer....if the caregiver makes no attempts to try to communicate with the patient.

I have never forgotten that experience.

[Sabby_NC]

If JCAHO were to get hold of this, they'd chew up your administrators and spit them out so fast it would make their heads spin.

Restraining patients is supposed to be the very LAST resort. It is a violation of their dignity and their rights as human beings to restrain them for staff convenience, or to save money.

If I were in your position, I'd get a hard copy of this new policy and send it to the Joint Commission, along with a letter stating just what you've told us. Be as objective as possible, supply whatever documentation you have, and leave the emotionality out of it---the regulatory powers that be don't have time for anything but cold, hard facts. If you are a union member, involve them as well; they have experts and attorneys who may be able to advise and assist you in preparing your case against your employer.

A word of caution: make sure JCAHO keeps your identity confidential; even though they cannot legally do so, employers have ways of retaliating against employees who 'rat them out' to the Joint Commission. (There are so-called "whistle-blower protection" laws on the books, but employers who really want to get rid of someone will almost always find a way, even if they have to manufacture it.........the laws really only help AFTER one has been fired.) I don't want to scare you away from doing what's right, but you should be prepared for anything......a hospital that will restrain patients to save money on sitters won't think twice about getting rid of a "troublemaker" employee.

I wish you the best of luck. You know this policy is wrong; otherwise you wouldn't have brought it up. Thank you for fighting for your patients' dignity and safety!

Exactly. Well said and written post.

[Sunflowerinsc, ADN, RN]

JCAHO regs for restrains are so strict and take so much time ,a sitter right away would be lots cheaper! Plus all the fines ,ect over not having the right orders and follow ups in place. To start with, has to be a medical reason to restrain a pt. Other than on a vent, its very hard to have a medical reason. Now if it is a physc reason, maybe resrtains (order is only good for a couple hours,ect). New reg in effect now also if someone who dies has been in restrains in past 24 hrs, extra reporting has to be done. Not all families can come stay with a pt, but restrains are not the answer for good (or moral and human ) care. Years and years ago ,anyone who just looked like they might fall (or pull out a IV) ,restraints were used. But it didn't keep IV's from being pulled out and sure didn't prevent falls. Made for more falls and injuries as pt's were more agitated and fell or hurt themself more from trying to get out of the restraints. I am wondering what type of facitily poster is working at that jump straight to restrains?