My mom's brother just had bypass surgery on Monday and has apparently been dealing with ICU psychosis. He is normally somewhat claustrophobic and with everything else going on in ICU, he is having difficulties. The nursing staff had to resort to applying restraints as he was trying to take out his iv and other various tubes. A friend of my uncle's wife is now trying to tell my mom that this is illegal. I don't see how that is possible when they are just trying to prevent him from hurting himself. She asked if I had ever heard of anything like that and I told her that I would look into it. Any thoughts or experiences would be appreciated. Thanks.
May 15, '03
Kats... take a look at my reply in the CCU forum.
May 16, '03
Restraints are a difficult issue and nurses are obliged to always try the least restrictive first. We have policies to guide decision making. Sometimes we ask family to sit with the patient to calm them, to prevent pulling of lines. This works best with anxiety, but psychoses is more difficult. Sometimes family observing psychosis is too overwhelming for the family, and they cannot be expected to safeguard multiple lines and tubes in such difficult times..
You are correct when you say the nurses are trying to prevent him from hurting himself. Because if he does, the nurses will hold responsibility for that. This is why it is a tough issue.
I hope your uncle recovers. Best wishes!
May 16, '03
Our facility has a restraint policy which regulates all use of restraint including 4 siderails. There is a restraint order form, restraint checkllist, specific documentation and intervals of staff checks of patient and release of restraints. The House Supervisor must be aware of the use of the restraints. A Dr order is required and of course all other measures must be tried first.
Pretty sure this was a NY State mandate.
May 19, '03
Hate having to place patients in restraints. It is a last resort, legal with documentation of doctor's order and documentation of need for them and monitoring ( protect airway, tubes, and for patient's safety).
May 19, '03
In NY state, if there is a valid need for the restraints usually a doctor must be notified that you are placing the pt in restraints and the supervisor must be notified. Then the physican must come in to evaluate the patient and write orders, which must then be renewed q24 hours. In an aute setting such as SICU, where the pt could be in danger of self injury from pulling out lines,doctors usually anticipate these problems and write orders accordingly. The main problem is if you can get the pt out of the unit and decrease the external stimulus to help resolve the ICU psychosis, the need for restraints to prevent self injury decreases. I hope he recovers quickly and returns to his normal self soon.
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