Nursing Director removed my pts restraints

[remotefuse]

So I had a disagreement with my director recently. She was doing her rounding when she came into my pts room. He was in soft wrist restraints for being confused and super violent. The first time I saw him he nicely asked me to come over in a whisper. I came close to the head of the bed and he folded himself in half with remarkable speed and tried to kick me in the face. Among a lot of other things, he was just violent.

He had been in restraints for 2 days, I saw during my assessment that he was using a lot of accessory muscles in breathing. The acessory muscle usage had also been documented for about a week, but lungs were CTA and great sats. Also, multiple MDs had rounded on him.

Director saw the accessory muscle use and told me that we're not having a pt die in restraints. I told her I wouldn't go near him without restraints on.

I go go back in there and he was untied and slipping out of bed. There was no way I was going to help him into bed alone. So I got 2 other people and by the time we came back he was on the floor.

I was really upset about it because I told her all the things he had done, but she insisted that dying in restraints is a huge deal, and maybe a sitter would be a better alternative. I didnt get in any trouble or anything for the fall, I just think the whole thing was a bunch of nonsense that I really didn't need.

[CelticGoddess, BSN, RN]

No one should die in restraints because of Terminal Restlessness.

Any Palliative/Hospice Nurse and doctor can relieve restlessness, pain, anxiety, shortness of breath, so keeping the patient comfortable without restraints. Music, soothing words, human touch, lavender oil, repositioning and massage can also help this transitional phase of the dying process.

Identifying the cause of such behavior is imperative.

I don't recall the OP stating the patient was terminal. I do recall her saying that he was violent and a fall risk. When his restraints were removed, the patient was attempting to climb out of the bed. No nurse should have to put herself at risk because a patient is violent.

I worked on a palliative care unit for 2.5years and I am now a hospice nurse. I know how important it is to keep terminal patients comfortable. I also know that most (I'd say over 95%) of terminal patients with terminal restlessness were NOT violent, nor were they actively attempting to crawl out of bed. Typically meds coupled with soothing voice and touch were enough to calm my dying patients.

I would caution you on the use of lavender oil. It can trigger asthma symptoms in some people, completely defeating the purpose if that person is your patient. And as we don't typically know the medical history of the family, they should be asked before use.

[JKL33]

No one should die in restraints because of Terminal Restlessness.

Any Palliative/Hospice Nurse and doctor can relieve restlessness, pain, anxiety, shortness of breath, so keeping the patient comfortable without restraints. Music, soothing words, human touch, lavender oil, repositioning and massage can also help this transitional phase of the dying process.

Identifying the cause of such behavior is imperative.

One thing's for sure - it's probably not a good idea for otherwise-uninvolved people to make executive decisions about such things and then walk away without further attending to the patient or helping troubleshoot the problem.

[jdub6]

In my state death in restraints is reportable with the exception of ICU patients who die in 2 point soft wrist restraints. (There may be an exception for comfort measures also but I'm not sure.)

Regardless its definitely reportable if they fall and its never smart to remove restraints and leave without telling anyone. That's incident reportable in my opinion.

And it's also not okay to have a patient with restraint orders and no restraints/doc not aware-so when she removed the restraints she should have discussed with MD.