No Restraints

[B52, ADN, BSN, MSN, RN]

I'm just venting. I work on a new psych unit and so far we haven't been allowed to use restraints. I'm afraid someone will die or be seriously injured before we put a patient in restraints. A 300-lb guy went on a rampage and he was not put in restraints. Another guy attacked staff on 3 occasions, each occurrence more violent than the last, and still, no restraints. (I was his first target.) During his latest outburst, I refused to go within striking distance, which meant I was not going to administer the Haldol and Ativan.

I'm almost ready to turn in my badge and get the heck out of there. This patient belongs in a state hospital.

[KatieMI, BSN, MSN, RN]

My life and nursing experience says that if one starts to get repeated thinkings about GETTING THE HECK OUT OF THERE WHATEVER IT TAKES, then it is most possibly the time to do just that and get the heck out of there.

[Jules A, MSN]

I can't think of the last time we used restraints on the inpatient psych units I work. Why wasn't he just medicated and then secluded if necessary? I don't know about your state my mine has very few state hospitals any longer leaving the inpatient acute units to care for chronic patients as needed when the group home environment isn't working, which is quite often.

[hppygr8ful, ASN, RN, EMT-I]

Restraints are a tricky thing because you must have a doctor's order to administer them and state laws require that psych patients be treated in the least restrictive manner possible. Since this is a new unit I would ask if there are experienced psych nurses on the unit who know how to deescalate a out of control patient. Also what is happening to escalte these patients. I worked Psych for a number of years and the only two times I was hurt was when we were doing take downs. The best case scenario is to prevent escalation when ever possible.

Hppy

[MrChicagoRN, RN]

Restraints are sometimes neccesary for safety, but are never theraputic. They are nor the be all and end all. In fact, they are considered to be a therapeutic failure by many.

If they won't restrain, please Share What Was done, and tell us how that worked out.

[B52, ADN, BSN, MSN, RN]

This particular patient was given an Ativan-Haldol-Benadryl cocktail, which didn't even make him yawn. He was also put on 1:1 observation, yet he still made an attempt to attack another nurse. Even the veteran psych nurses were taken aback.

[MrChicagoRN, RN]

Do you have seclusion available?

Regarding the meds, sounds like they,should've then moved up to something like Thorazine or Zypexà if still agitated

[B52, ADN, BSN, MSN, RN]

I agree. The practitioner keeps increasing Haldol rather than trying a different antipsychotic. That's the real problem. We do have a quiet room and a seclusion room. He has been in neither, just because.

[RatchedAfterMidnight, MSN, APRN]

I work in a psychiatric facility that does not have physical restraints on the property, we simply do not believe in them. If a patient is actively at risk of harming others he/she should not be running around the unit "on a rampage." A code should be called, staff should strategize how they'll do the take down, CPI/non violent intervention strategies should be utilized appropriately, and the patient should be escorted to the seclusion room/given IM injections until he/she is no longer a threat to others. He should definitely not be given the opportunity to leave the seclusion room if he is still attempting to strike nurses. Your staff can do a physical hold/restraint on the patient to allow you time to administer the IM injection if he is actively a threat to self or others. If you do not have access to an adequate seclusion room or consistently do not get adequate support from staff throughout the facility when you call a code, you've got a big problem. With the little information you've given, it doesn't seem like the patient is the problem (lots of aggressive psych patients in the world) but training/teamwork may be lacking. Decide if it's worth sticking through process improvement on the new unit!

Edit: No seclusion just because? Oh my goodness he should have been in seclusion for awhile it seems like! There's the problem.

[tyvin, BSN, RN]

Such BS when they are using retsraints...chemical restraints. I worked on one of those units and there was more harm than good with the amount of psych meds they were using...

Medications are a form of restraint absolutely!

[Juryizout]

I'm finding that facilities are more focused on days without seclusions/restraints and will chastise the staff member who makes the call to use either of those. It "messes up the numbers", regardless if staff have been injured or not.