Dplear, in this part of the country, restraints are not used routinely when a patient has life support equipment in place. That is part of why these new regs. are so nasty-- in my 28 years of critical care in hospitals here in Mn., we have never used restraints on patients UNLESS the patient is in danger of harming himself (being confused and actually pulling at lines or trying to get out of bed) or harming someone else (violent and/or combative).
As I stated above, the policy we had in place was that a physician had to be notified and orders written within 12 hours of the restraints being applied; then those orders had to be renewed each day by the MD, and the RN could do the assessment re: the patients mentation and confusion.
Now that isn't good enough! These are brand new regulations this month, and whatever was a policy before is no longer adequate.
Barbara Rose, I am shocked and dismayed by your comments! Yes, I realize that LTC has had much different rules than acute care has had over the past few years. But for LTC and acute care to have the same rules regarding restraints? Come off it! You know which patients can become combative--you know your patients histories... you usually know what their previous behaviors were in different situations- that's why it is called LONG TERM care!
I love geriatrics, and started out as an aide in a nursing home and plan to someday go back to LTC when critical care finally gets too stressful for me. But we knew who had tendancies to wander, or hit, or harm others: we knew our residents very well. And they didn't have arterial lines or balloon pumps or other dangerous tubes and lines that, if dislodged, could cause them permanent injury or their death in less than 30 minutes. I know LTC has changed a lot since I was an aide, but you still get to know your residents much better than any acute care nurse ever could in the short hospital stay that modern health care forces on both the patient and the nurse.
The big difference is that our patients are in hospitals for such a short time that we never get to know them well enough to predict what they may do as their mentation changes (for instance, as anesthesia wears off, or how they may react to pain or meds).
I had a patient tell both the admitting nurse and his MDs that he was a "social drinker" and had a drink once a week. He went into full blown DT's on a Monday night after being hospitalized for 4 days; and it turned out that his definition of a "social drinker" was a case of beer and a quart of whiskey every Friday night! (I'm not sure what he thought all of those beers were, but to him they didn't count as "a drink!" Who knows, he may have drank a case of beer every night too!).
We do use many alternatives to restraints in acute care; we have sitters, the bed alarms and warning systems and other devices, but most of them won't work if you have someone pulling out their feeding tubes because they think it's a "buger" when you turn away from the bed for an instant (I know, they can do that in LTC also). We also use a confusion kit with lots of stuff for the patients to keep their hands and minds busy and out of trouble.
I understand that LTC residents' beds may be on the floor these days, but be realistic! How do you get a fresh surgical Patient in and out of a bed that way several times per shift?
Would you like to try it?