Opinions and Experiences with Patient Restraints?

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Hello! I'm doing a group presentation in nursing school and we've been assigned the topic of "The Use of Patient Restraints". We're just beginning our research (we were assigned the topic today) and our presentation is on December 3 - so we have a good amount of time. We thought it'd be interesting to get the perspective of the experienced nurses of allnurses.com! Anything you can share with us would be so helpful - from your own experiences, your own hospital's policy regarding restraints, your opinion about them, things you've observed, etc. We've only done one clinical rotation so far and none of us have any personal experience with restraints so we'd really like to hear some first-hand accounts. Thank you in advance!

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Specializes in LTC, Psych, Hospice.

The only restraints that are allowed in my area are side rails, gerichair trays, lap belts in wheelchairs. All of these need a physicians order and family permission. Of course there are also chemical restraints, but the above rules still apply.

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Specializes in Pediatrics, ER.

What kind of restraints are you talking about? Physical holds, chemical restraints, or mechanical restraints? Are you talking about use in regard to a hospital setting, or an inpatient psychiatric facility?

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I work in a Medicine step-down unit. We are a small unit, only 12 beds, but at any given time I would say we have at least one patient in restraints. Bilateral soft wrist restraints are the most common. 3 points are also common, because when you go up to 4 point restraints our policy is that there has to be a PNA (sitter) with the patient at all times. Sometimes we use the soft restraints for 4 points as well, but if they're being very aggressive/combative, we call hospital police and get a special key for 4 point leather restraints. I've been on the unit 1 year and have only had 3 patients in leathers, so it's not super common but not unheard of. I think it's absolutely necessary to implement restraints. Pts risk pulling out medically necessary devices or getting out of bed due to confusion and falling and injuring themselves. We have 3 patients total per RN, so we can't spend all of our time babysitting one.

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Specializes in ED.
What kind of restraints are you talking about? Physical holds, chemical restraints, or mechanical restraints? Are you talking about use in regard to a hospital setting, or an inpatient psychiatric facility?

Yeah, that.

One thing that is unique to the floor I work on is that we often have an inmate (or 3) on our floor. An interesting angle might be the use of handcuffs vs what the hospital policy is regarding the use of restraints.

I work as a tech on a family practice unit. One night another tech called out leaving us with only 2 techs. I had about 25 patients to care for that night. Out of those 25 I had THREE inmates! Two of them were completely cuffed and shackled to the bed and the other just had one hand cuffed.

As a nursing student, i had a million and one questions for the nurses that night. The one question that had many answers was, "Who keeps the keys?" I mean me ARE responsible for his care and if we run into a code situation and those guard goons are so clueless sometimes would they even know to take the cuffs off? Why don't WE have a key?

If I had to do a paper, I think I'd have to consider this for a topic.

meredith

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jax14,

I'm a tech who is also in nursing school. At the hospital I work in, there is no holding back with the use of restraints. I work in IMC and ICU and 5 out of my 14 patients may have restraints any given day. Most common are the soft wrist and ankle kind. I've seen 2 point and 4 point used regularly. I've seen mittens used sometimes, and a roll belt used once. In ICU, if the patient is intubated, they must be restrained (2 point). In IMC the most common reason for using restraints is the patient continues to try to get out of bed and the bed alarm is not solving the problem, or they continue to pull out IVs.

My personal take on restraints:

I think we as techs, nurses and doctors too often turn to restraints to solve behavioral issues. I hate that our patients think we are tying them up, or trying to hurt them. Sadly, in most cases I've been a part of, having a sitter or family member in the room constantly would eliminate the need for restraints. However, most of the time it is not feasible to have 5 sitters on one unit, and family members often do not feel comfortable restraining the patient themselves.

Argument for: recently on my unit, a combative patient who was not restrained but rather had a sitter, severely injured my co-worker. She was trying to keep the man from getting out of bed and he grabbed her wrist, twisted and BROKE IT! This is an example of when a patient cannot be restrained by an employee, the patient must be restrained with mechanical restraints.

I vote for limited use. But yes, sometimes they are necessary for everyone's safety

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Specializes in ER.

After practicing a few years I really think that physical restraints should always be accompanied with chemical. Patients should be protected from the mental trauma of being trapped, and if they are agitated enough to need a restraint they deserve a calming med. If there is no agitation, they are just wandering then I would agree with a no restraint policy and using adaptive devices.

Hospitals don't want to pay a sitter for every patient, but using the old fashioned wards provide company and distraction for confused patients, and allow one nurse to always have eyeballs on everyone. I'm talking about a sitter hired only to watch and distract while private nursing care is done with curtains closed. And a sitter that is constantly chatting and providing activities- not just SITTING.

I work in the ER. I've seen enforced chemical/behavioral time outs work very well for acute issues. Patients can wake up with a whole new outlook, and are usually better able to express themselves, even in conflict. Sometimes people get dug in to their position, or psych issues don't allow a restoring sleep, and the simplest problems trigger a huge escalation. Time outs are needed for adults sometimes too. (sometimes for staff, but thats a different thread)

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Specializes in Pediatrics.

Work in a ED and we have to use restraints a couple of times a day.

Allways aim for the least amount of restraint as possible and remove the restraint as soon as possible

For the 4 point restraints on the wrist and ankles, they:

- 1st need a MD order within 20mins of them being applied

- the pt requires a sitter, incase they were to some how hurt themselves with them on

- circulation needs to be checked by a RN q hourly

- we must document q hourly that their ADLS are being met

- anytime restraints or a sitter is used there is seperate documention that has to be filled out showing what they are doing every 15 min as a way to validate the reason for the reststraint

I have seen pts put into 5 point restaints, however they were high on PCP and took about 10 of us to get the pt on the bed ( one CNA ended up with her fingers broken and a nurse was in a choke hold)

In our psych units I have seen ankle shakled together and one wrist restrained to the waist and the other arm free, so the pt could still move around the room, but they could not take off running to hit or kick anyone ( pt even though not restrained to a bed still had to have a sitter (me) ) untill the pt could agree not to hit anyone

For our pts that are intubated we use soft wrist restraints

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Specializes in ICU, MedSurg, Medical Telemetry.

Dumb question -- is this a restraint that could get me in trouble? I had two confused pts the other night, both of whom were pulling at their IVs and foleys. One even pulled out their IV & I had to replace it.

The one had been wearing (untied) mitts when I arrived to the floor and had had them and the bed rails up x4 while the family was in the room. The other, a new admit, kept climbing out of bed and pulled out his IV. I explained to him that I didn't want him to hurt himself and put up the rails and bed alarm. He was confused, but he agreed. I also put untied mitts on him, explaining to him that he didn't want to pull out his IV again (caught him pulling at the new one even after I covered it with a gauze "sock") b/c he didn't like the stick the first time. He agreed initially and even when he pulled it off later, he was agreeable when I explained once more why I put it on.

The nurse who had him during the day said later that this was actually a form of restraint, which really upset me since I would NEVER purposefully restrain my patients and had thought I had done all I could do to not to restrain them based on their circumstances. I am not angry with the nurse who told me (he was nice enough not to report me), but I do need more information for future reference. Did I really restrain my patients in an illegal way? I was under the impression in nursing school that unless you tied the mitts, mitts were not a restraint.

Am I wrong? I really don't want to make a mistake like that again if I really did do something wrong.

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Specializes in ER.

franciscan-

If the patient was able to remove the mitts himself he was not restrained. Restraints prevent the usual movement or use of a limb, if he could still take it off and use his hand if he wanted to I would vote not restrained. It's a fine line though. If you charted the teaching and pt agreement to the plan of care I think that would serve you well.

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Yeah, that.

One thing that is unique to the floor I work on is that we often have an inmate (or 3) on our floor. An interesting angle might be the use of handcuffs vs what the hospital policy is regarding the use of restraints.

I work as a tech on a family practice unit. One night another tech called out leaving us with only 2 techs. I had about 25 patients to care for that night. Out of those 25 I had THREE inmates! Two of them were completely cuffed and shackled to the bed and the other just had one hand cuffed.

As a nursing student, i had a million and one questions for the nurses that night. The one question that had many answers was, "Who keeps the keys?" I mean me ARE responsible for his care and if we run into a code situation and those guard goons are so clueless sometimes would they even know to take the cuffs off? Why don't WE have a key?

If I had to do a paper, I think I'd have to consider this for a topic.

meredith

If there is an inmate on your floor, there should also be a police officer or a correctional officer with that inmate, and they keep the key. The nurse doesn't get the key, because they aren't law enforcement, and have not been trained to use handcuffs (yes you have to be trained). Also, for safety purposes--if that nurse that is holding the key walks away from that inmate for even a second...imagine how long it could take you to find him/her if you had to unlock the patient for something, whereas the officer is right there (or should be). The handcuff key is also a part of their uniform, if they gave it away to a nurse, that would be the equivalent of them giving their gun away. In my district (my ex husband was a cop), the rules were laid out very simply: inmate for a patient, you also have an officer boarding in that room...they get a private room unless there are two inmates on the floor, then you can have 2 inmates and one officer. At the very minimum, they have to have one limb secured to the bed at all times with a shackle or hand cuff. No visitors allowed. And all obstacles must be removed from the room that weren't necessary, so the room was stripped of everything except the bed, the chair for the officer to sit in, and the bedside table. The chair where the officer was sitting had to be positioned in a manner that the officer could visualize both the door and the inmate without any obstructions. Our hospital required of the officer that the inmate be unshackled every 2 hours and re-shackled onto a different limb to allow for mobility. We also continue to follow standard protocol for restraints (toileting, checking for breakdown, etc)...All facilities should have a protocol on how to handle inmates on their floors--and they should be accompanied by a member of law enforcement...just because they are no longer within the confines of the prison walls, does not mean that they are not still in custody--so I imagine that those "goons" are probably well versed in getting an inmate in and out of handcuffs.

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Specializes in Med surg, hospice.

The mitts are restraints. The patient was unable to drink or go to bathroom with mitts on. You have to provide documentation that you are helping with those needs. All four side rails up are restraints. If the patient request the side rails up then it is not restraints.

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