My facility is restraining a resident and I feel that I can't help.

[Nursingstudent___]

Hello, I'm just a nursing student and a nursing assistant, but I learned in my fundamentals class that if a patient can't move a barrier, it is considered a restraint. So anyway, I work in an unsafe CBRF (community-based resident facility). My residents don't get evaluated by a nurse, we have med pass people, but they are giving beta-blockers without checking for pulse and BP first. My resident had an issue after she got it, she had Bradycardia and Hypotension episode and ended up passing out.

I am really concerned about my residents, but most of all, I'm worried about the use of restraints. I have one resident who doesn't move at night. I know I'm night shift, and I go in there every two hours, and I know he doesn't move. We started using two big body pillows so that he doesn't "roll" out of bed. I have another resident we are doing this to, and she is perfectly capable of getting out of bed herself, and she has a motion detector, but we are still stuffing a body pillow under her sheet so she can't move. This goes against everything I learned in school, and the person who owns the CBRF isn't a nurse and has a business degree, so it isn't like she has a background in nursing theory or pharmacology or anything.
I don't know if I'm overreacting, and I'm not sure what to do either. I don't want to be a know-it-all nursing student because I don't know it all. But it seems wrong to me to have my residents restrained at night like that when it's not necessary, and the med errors also really bother me. What do you guys think because my facility doesn't have any nurses I would really like an RN's opinion

[MunoRN, RN]

Generally, people on beta blockers don't check their pulse or BP prior to BP, and it terms of nursing practice it's not a standard of care. There are certainly times where evaluating a patient's response to a beta blocker is indicated, such as after starting on the medication or changing the dose, but that's better done at the expected time of peak effect, not prior to the next dose.

Restraint use isn't illegal, but it is regulated. If the patient can move or remove the pillow, then it's not a restraint, if the patient can still get out of bed then it's not a restraint, if it's to keep a patient from 'rolling' out of bed while sleeping rather than preventing an intentional act then it's also not a restraint. It's hard to say if the use of the 'body pillow' is inappropriate without further context.

[Nursingstudent___]

5 minutes ago, MunoRN said:

Generally, people on beta blockers don't check their pulse or BP prior to BP, and it terms of nursing practice it's not a standard of care. There are certainly times where evaluating a patient's response to a beta blocker is indicated, such as after starting on the medication or changing the dose, but that's better done at the expected time of peak effect, not prior to the next dose.

Restraint use isn't illegal, but it is regulated. If the patient can move or remove the pillow, then it's not a restraint, if the patient can still get out of bed then it's not a restraint, if it's to keep a patient from 'rolling' out of bed while sleeping rather than preventing an intentional act then it's also not a restraint. It's hard to say if the use of the 'body pillow' is inappropriate without further context.

Thank you for the reply. I learned in my pharm class that we were supposed to assess bp and hr prior to giving a beta-blocker. However I also understand that what we are taught is not always the same as how something is done in the real world. I appreciate it a lot.

[Rose_Queen, BSN, MSN, RN]

2 minutes ago, Nursingstudent___ said:

Thank you for the reply. I learned in my pharm class that we were supposed to assess bp and hr prior to giving a beta-blocker. However I also understand that what we are taught is not always the same as how something is done in the real world. I appreciate it a lot.

The setting determines the need to check vitals. Most schools approach teaching from the viewpoint of an acute care (hospital) nurse. Yes, patients in the hospital are going to be monitored much closer- and not just HR and BP. Standard vitals includes much more.

However, the view of a community setting where these meds are not new but rather are routine for the patient doesn't require that closer monitoring. These patients, in comparison to the acute care patient, are stable- they are not sick enough to require inpatient care and thus do not need the same level of care.

Restraints are also viewed by what the purpose is. Being in the OR, I routinely place straps around the arms of an anesthetized patient. In this scenario, it's a safety measure as opposed to a restraint as the purpose is not to keep the patient from doing something but to protect the patient from injury by ensuring that the arm is not going to fall off the armboard and result in a brachial plexus injury. Even mitts are not considered a restraint on inpatient units at my facility- it's a safety measure. The same is true of the arm support that maintains the correct positioning for an arterial line. Now, using a soft wrist restraint and securing it to the bed with the purpose of not allowing an awake patient (even if sedated) to reach various things (endotracheal tube, IVs, etc) is a restraint.

[mmc51264, BSN, MSN, RN]

I don't agree with the not checking VS before give a cardiac med. We always check BP/HR when giving any cardiac med. Maybe the difference is acute care vs non-acute care, but your instincts and training are correct, you should be assessing that stuff before giving.

As far as the restraint issues, I am not well-versed enough in the type of facility you are working in. It does sound like there might be something a little wonky.

[Rose_Queen, BSN, MSN, RN]

Just now, mmc51264 said:

We always check BP/HR when giving any cardiac med.

But a patient at home doesn't do a daily check. For these patients, it is their home setting. I sure as heck don't check my HR and BP before popping my losartan.

[mmc51264, BSN, MSN, RN]

That is true for you, but if someone else is caring for another person and they give it w/o checking, and that person gets hurt, guess who is liable?

I know people that take their own BP daily before taking meds.

[Lunah, MSN, RN]

4 minutes ago, mmc51264 said:

I know people that take their own BP daily before taking meds.

I don't check my BP or HR before I take my beta blocker and losartan. I check my BP once or twice a month, at most. Unless you are tweaking dosages or feeling off, it's not necessary unless otherwise directed by a provider. As a matter of fact, I was told to NOT get too crazy with checking my BP. Lol.

[MunoRN, RN]

30 minutes ago, mmc51264 said:

I don't agree with the not checking VS before give a cardiac med. We always check BP/HR when giving any cardiac med. Maybe the difference is acute care vs non-acute care, but your instincts and training are correct, you should be assessing that stuff before giving.

As far as the restraint issues, I am not well-versed enough in the type of facility you are working in. It does sound like there might be something a little wonky.

Assessing the effect of the beta blocker for the extent to which it slows HR and blood pressure prior to the dose doesn't make any sense. If that's what you're assessing, it should be assessed at the time of peak effect.

But generally, once the effect of a certain dose of the medication has been assessed, there's not much to be gained from repeatedly assessing the same thing.

[Nursingstudent___]

1 hour ago, Pixie.RN said:

I don't check my BP or HR before I take my beta blocker and losartan. I check my BP once or twice a month, at most. Unless you are tweaking dosages or feeling off, it's not necessary unless otherwise directed by a provider. As a matter of fact, I was told to NOT get too crazy with checking my BP. Lol.

Thank you for the information I will keep this in mind.

1 hour ago, mmc51264 said:

That is true for you, but if someone else is caring for another person and they give it w/o checking, and that person gets hurt, guess who is liable?

I know people that take their own BP daily before taking meds.

That's why I'm confused. She has extremely bad dementia and can't be in charge of anything so should the med pass person be assessing her condition after a med?

[Lunah, MSN, RN]

9 hours ago, Nursingstudent___ said:

Thank you for the information I will keep this in mind.

That's why I'm confused. She has extremely bad dementia and can't be in charge of anything so should the med pass person be assessing her condition after a med?

Is your med pass person a licensed health professional?

[mmc51264, BSN, MSN, RN]

23 hours ago, MunoRN said:

Assessing the effect of the beta blocker for the extent to which it slows HR and blood pressure prior to the dose doesn't make any sense. If that's what you're assessing, it should be assessed at the time of peak effect.

But generally, once the effect of a certain dose of the medication has been assessed, there's not much to be gained from repeatedly assessing the same thing.

If someone has a HR of 48, I am holding the dose of a BB and telling the provider. I guess I am just use to inpatient care not LTC. Forgive me.