Nurses calling POA to notify

[NurseB96]

Hello,

My main question is when do nurses have to call family members to notify them? I am new nurse on orientation. I had to call the doctor about mitts and I got an order to put them on my patient at 10 pm.

At 5 am, my preceptor told me it was my responsibility to call the family member to notify them about the mitts. I was taken aback because I never had to call a family member before about anything. I can understand calling the poa for extra information if the patient is unable to tell me, but I never knew as a nurse that I would have to notify a poa. I called and I didn’t get a positive response because I was calling so early in the morning and the doctor had already called her about it.

So I am a little confused if it was a mistake to call as a nurse. If the doctors call, why do I need to call also? If nurses are required to call, what else do we have to call about? Because I never had to call the poa even when I had a rapid response.

I have asked my preceptor those questions and she told me that the doctors don’t call and nurses do the calling when it comes to restraints. I work on a tele med surg floor. I can’t help but feel like it’s a bit incorrect and just want to hear second opinions.

Thank you

[old&improved]

I work nightshift and I have not called a family member about restraints unless I was also calling them to help calm down a confused, angry, paranoid patient or to come in to sit with them if they were able. I have found family generally is understanding about restraints because they know it may be needed to keep the patient from pulling medical equipment out and to keep the patient and/or staff safe. If I call them in the middle of the night it's usually to give them the option to come in and sit with the patient if they want or to relieve the confused patients anxiety. If I had to restrain a patient in whom it was completely unexpected (a young, a&o person with no known drug/alcohol use) then I would call family to let them know because it would be a huge and unexpected change in condition.

[NurseB96]

Ok that makes sense. Thanks. I am sure it wouldn’t have been unexpected to the family. The pt was confused and had pulled out the NG tube out the previous night. And the pt had almost pulled out the new one , prompting me to ask the doc for mitts.
It sucks my first phone call to a family member didn’t go well, but I want to learn from the mistake.

[Sour Lemon]

I've only worked at three hospitals, but it was policy to contact family at all three when restraints were ordered and applied. I usually called on my way out the door since I worked overnight.

I have never heard of a physician calling family for that reason. That seems very odd, to me.

I've also never seen soft mitts, alone, qualify as a restraint. They'd have to be attached to the bed for initiation of the restraint protocol. I've never even seen an order required for mitts.

As for rapid responses, I call when there's a signifigant change in status and the patient is transferred to a higher level of care. If it's something fixable, and the patient returns to their baseline, I don't call unless the family has specifically requested to be called.

[FolksBtrippin, BSN, RN]

When I worked inpatient child psych, it was my job to call the parent and inform if I had to initiate restraints on a child.

I would think you'd need to call a guardian but not a regular POA as I understand these terms. My understanding is that an ordinary power of attorney does not have rights to know medical info without a signed release but a guardian does.

[Susie2310]

5 hours ago, FolksBtrippin said:

When I worked inpatient child psych, it was my job to call the parent and inform if I had to initiate restraints on a child.

I would think you'd need to call a guardian but not a regular POA as I understand these terms. My understanding is that an ordinary power of attorney does not have rights to know medical info without a signed release but a guardian does.

I don't know if this varies from state to state, but I can confirm that in my state a DPOAHC form that I am familiar with gives the patient's designated Agent the right to examine the patient's medical records unless the patient limits that right in the DPOAHC document. It is also possible that a patient, in accordance with the laws of their state, has executed a legal document that authorizes their Agent to receive HIPAA information.

[amoLucia]

My guiding rule of thumb was to ask myself - would I WANT TO BE ALERTED as soon as reasonable/possible if the pt were my relative or charge/client??? I usually found that YES, I personally would want to be informed ASAP. That decision-making question guided me.

Like other PPs commented, mitts can be determined to be a form of restraint. I would use the word 'RESTRAINT' very gently, classifying it a SAFETY RESTRAINT. That took the harshness out of my communication. To me, restraint is any artificial device or activity that hinders the pt from doing what s/he wants to do (even if it is negative action). I NEVER wanted a family/acquaintance to visit and find an UNPLEASANT SURPRISE like a restraint.

When in doubt, I always tried to err on the SAFE SIDE and call/alert. On 11-7, I, myself, tried to make the call last thing before I left work. I could give the best information first-hand. Physicians very rarely ever make those kind of phone calls.

Notification (and possibly consent) is usually REQUIRED for any restraints, change in status, significant med addition/reduction/discontinuance, bruise or injury of known/unknown origin, etc. Again, I never wanted any surprises for anyone.

I figured my being upfront in a timely fashion would fare better to alleviate or avoid surprises or suspicion.

Finally, remember to make sure your actions are ordered, documented and care planned. As a newbie, ask your coworkers/supervisor if there is anything else to do.

[PhillyRN, BSN]

The MOST important thing is understanding your facilities policy on restraints! I worked in long term care at my first job and we called family members about everything. Falls, wounds, etc....

In the hospital, some facilities require the nurse to make the calls but at my present job it's on the physician! They have to explain the medical or behavioral reason for application.

The only time I may discuss with a family is if the pt is displaying behaviors that would justify the restraint while the family is present.

ALWAYS CHECK THE POLICY! CYA.

[MunoRN, RN]

There are no clear-cut universal requirements for keeping a POA informed about restraints, but in my experience there aren't all that many scenarios where we either haven't already discussed the potential need for restraints in a confused or delirious patient, or where you wouldn't be notifying the POA that of the patient's condition that is now requiring restraint use, where the actual application of restraints isn't the primary reason why were talking to them.

If we've already discussed the patient's confusion or delirium with the patient, or sometimes that they will most likely become delirious, then we typically include that restraints may be needed to facilitate medical treatment, in which case we wouldn't call to discuss something we've already discussed unless the POA specifically wanted to be notified at the time of restraint application.

[Asystole RN]

There are some items you need to clarify that will be hugely important.

1) What kind of POA and what does it say? Medical POA?

2) What is your state's legal requirements and rules regarding POA?

3) What is your facility policy on restraints?

POA is a confusing concept that is determined by state law and the type of POA the patient authorized.

[CrunchRN, ADN, RN]

As a nurse and family member I would just be happy you kept them safe, and I would just ask about circumstances when I visited and saw it.

[KatieMI, BSN, MSN, RN]

Policy and safety, it's all good.

But if it all happened at 10 PM, why a nurse must call at 5 AM? If it is already full seven hours late, why it was not possible to wait another 90 minutes when there is no apparent emergency?

Things about what is that POA, and what kind, and especially "what are state's legal requirements and rules" should be determined, delineated and made easily available by administration, and whole well before anything happens. It is not realistic to expect an exhausted bedside RN (and a new one at that, as the TS has a preceptor) to go online at 5 AM and peruse a mountain of documents written in "legal English". But, really, it is also not realistic to expect an ordinary human feel anything but very grumpy if he/she was woken up at 5 AM "just for an update about safety". It should be done at 10 PM if it at all should be done. But non-emergency update can wait till more humane hours to be delivered.

P.S. I saw quite a few POAs and families, both as nurse and as provider, who expected to be called at once about "everything". By "everything", they meant just that - everything, and sometimes by doctor in person. Patient just changed TV channel, patient is upset that one football game ended not the way he wanted, patient asked for a drink and got it, and so forth 24/7/365, and some "boutique"-type practices really do it. I usually give one nice, polite and absolutely no-nonsense talk about what nurses are there for, and that ends the discussion.