Over-Restaining Patients

BackInTheGame · Jul 17, 2006

Ok this is going to sound horrible but there are times where I miss restraints. Not for my convenience but sometimes, they are needed for patient safety. We have a ZERO restraint policy and we get yelled at just for putting both siderails up on a bed. We've been able to reword some things, like lap buddy's being an assistive device (they're listed as restraints at our facility). One doc thought it was used to restrain someone until he saw the resident without it and realized that she constantly leaned forward in her chair and it really was necessary not only for her safety, but also for her comfort. Without it she leaned across her overbed table all day. I miss the days of being able to use a soft vest for someone in a chair. Instead we've become experts at the one second sprint across the unit to catch someone who thinks they can still stand unassisted. Had to send a pt to the ER the other night because her mind refuses to wrap around the fact that she needs help transferring. I agree that restraints, as a whole, should be avoided at all costs but sometimes they truly are necessary.

Melina · Jul 17, 2006

I don't have any experience in LTC other than my father's rather long stay in one. He had issues with falls, and the staff ended up giving him a mattress on the floor so they wouldn't have to keep him restrained. I don't know how feesible that would be at your place; it must have sucked for the CNAs who had to change bedding!

~Mel'

BackInTheGame · Jul 17, 2006

We have floor mats for fall prone residents when they're in bed. They're like larger versions of kindergarten mats so they fold up in thirds to make getting to the bed a lot easier... some times.

achot chavi · Jul 17, 2006

Thanks. I also think that the zero restraint policy is ridiculous. There obviously is a place for restraints to ensure proper sitting and safety for patients who really need them.

I was referring to patients who sit straight, are well-balanced and in general don't fall.

We also have a catch 22 as the restraint causes the patient to be agitated (and try to remove it) and then the nurses ask for meds to calm the patient down and guess what -before you know it the patient loses the ability to sit independantly!!

weirdRN, RN · Jul 17, 2006

There are a lot of laws that have been passed b/c at some point someone decided that in LTC and in Psych facilities the restraints were being abused. I think a more reasonable view of restraints is called for in LTC with confused residents who are prone to falls and other injuries caused by their age and conditions.

How to get that instituted under the current laws is the million dollar question.

chadash · Jul 17, 2006

I am not for zero restraints, just very limited restraints. The fact is, restraints pose there own safety problems. They never replace supervision.

That said, lap buddies are our friends. Again, keep the pt in view. A slider can hang themselves up!

Alarms are great. You do have to chase them alot, but that is better than a fall or a potential restraint injury.

This is just not an all or nothing situation. The caregivers and staff should determine what is best for the patient, and recommendations should be based on that: individual circumstances. Never for the convenience of the staff.

chadash · Jul 17, 2006

I am not for zero restraints, just very limited restraints. The fact is, restraints pose there own safety problems. They never replace supervision.
That said, lap buddies are our friends. Again, keep the pt in view. A slider can hang themselves up!
Alarms are great. You do have to chase them alot, but that is better than a fall or a potential restraint injury.
This is just not an all or nothing situation. The caregivers and staff should determine what is best for the patient, and recommendations should be based on that: individual circumstances. Never for the convenience of the staff.

Ooops! grammar police! I meant "their" :)

LPN1974, LPN · Jul 17, 2006

One doc thought it was used to restrain someone until he saw the resident without it and realized that she constantly leaned forward in her chair and it really was necessary not only for her safety, but also for her comfort. Without it she leaned across her overbed table all day.

I hope when I get old and in the NH that someone will have pity on me and help me to lay down on my bed instead of making me sit up in a chair all day or have to sit up straight with a thing in front of me or lean over an overbed table.

Could this be the reason that some patients might be trying to get out of their chairs? Ya think?

weirdRN, RN · Jul 18, 2006

I think that some residents, no matter where you have them, just want to climb. Some of them do not realize that they can no longer walk on their own, and need assistance.

BackInTheGame · Jul 18, 2006

The woman to whom I was referring demanded to get up out of bed. She wasn't forced, nor is any patient in the facility forced to get up or sit up all day. According to her, she wasn't raised to lay around in bed all day and as long as she had her say, she'd get up every morning. She also had severe kyphosis and was unable to sit up straight. Laying in bed was uncomfortable for her and sitting up and leaning was how she preferred to be.

achot chavi · Jul 18, 2006

1. What exactly are LapBuddies?

2. We all agree that restraints when used properly can be a useful tool, and unfortunately we don't have ideal staff to patient ratio to keep an eye on every patient all the time. Some situations do justify use of the restraint!

However when I did an inservice with my CNA's and restrained them all in different places, the point hit home- they were horrified by how demeaning and powerless they felt. Some became agitated, some cursed, they all agreed how inhumane it felt. Then I added the element of having a very full bladder and being restrained when the nurse asks you to wait just a half hour because she is busy administering meds...

3. Patients who want to spend the day in bed... thats a whole other story- are they depressed (justifyably so), are they bored, are they disgusted by the looks, sounds, and smells of the other patients, Are they in pain? Are they embaressed? Often we find a volunteer to take them for a walk in the park or play cards with them etc.