Over-Restaining Patients

achot chavi · Jul 18, 2006

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

You think thats bad? My tired fingers and eyes let "over- restaining patients" through. I keep waiting for a :trout: I guess nurses are really forgiving people!!

I once charted (in hebrew) that a family member came to "bury" a patient instead of "visit" a patient!!! In hebrew the two words are similar

weirdRN, RN · Jul 18, 2006

1. What exactly are LapBuddies?

lapbuddies are foam cushions that fit across the resident's lap and through the sides of the wheel chair. They are intended to keep the leaning resident from falling out of their chairs head first. Thus preventing head injuries.

I have also seen hard plastic trays used as lap buddies. The residents with those have generally been more alert and oriented, but b/c of stroke or other condition is unable to sit properly in a wheel or geri chair without some kind of safety device. Sometimes the trays serve as just that: trays so the resident has something to sit drinks, crafts or other things on to keep him or her occupied.

Home Health Columnist / Guide · Jul 18, 2006

fyi pics: wheelchair lap buddies

chadash · Jul 18, 2006

You think thats bad? My tired fingers and eyes let "over- restaining patients" through. I keep waiting for a :trout: I guess nurses are really forgiving people!!
I once charted (in hebrew) that a family member came to "bury" a patient instead of "visit" a patient!!! In hebrew the two words are similar

I am just glad the family didn't confuse their purpose for coming! That'd be bad....

weirdRN, RN · Jul 18, 2006

fyi pics: wheelchair lap buddies

thanks nrskarenrn! a pic really is worth a thousand words.

achot chavi · Jul 19, 2006

Thanks NRSKarenRN! A pic really is worth a thousand words.

Thanks to you both.

chadash · Jul 19, 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.

Some people do prefer to be up all day. Leaning forward on the lap buddy to a certain extent can shift the pressure on the bottom a bit. Some pts with breathing problems do better in this position.

That said, there is a real need for diligence on the part of the staff to prevent pressure sores. Ideally, a wheelchair pt should do a pressure release every 30 minutes. That is really important with paraplegic pts who do no weight shifting. Many elderly pts who are not paraplegic dont shift either.

But, at the very least, the pt shoud be changed or toileted every 2 hrs. That gets them out of the chair at least for a few minutes.

banditrn · Jul 19, 2006

I don't believe we have any kind of restraints in our LTC. We aren't even able to use side rails! Granted, when I worked in the hospital, putting all 4 rails up was just asking for some confused person to get hurt by climbing over them, but I've never thought the top rail restrained anyone un-necessarily, and can give them something to hold on to to pull themselves into a sitting position.

The body alarms are OK, except when they carefully take them off before getting up.

But I'm not sorry to see the other kinds of restraints gone - I always felt it was too easy to forget them.

weirdRN, RN · Jul 20, 2006

We have a lot of personal body alarms and lap buddies and seat positioning things. The problem is that many elderly, confused, residents forget that they can not walk. We have one lady who belevees she is twenty one and every day she has to be convinced that she can not walk. Consequently, every day she stands, and every day ends up on one knee. Then she cries because she can not remember how she got this way. Then we have to explain and reorient. It is quite tedious. I feel so bad for her. I feel so bad for me when I have to do the incident report everyday. It is ridiculous, but if we restrained her she might be hurt even worse.

thsnursluvsgeriatric · Jul 21, 2006

Hi, I have to agree that the restraint use in your facility is alittle to much.

It it is reminiscient of control and keeping fallstatistics low. I'm in favor of safety but not at the expense of the residents happiness. People talk about resident falls causing deaths, but their are many residents that get out of restraints and fall. They are in aweakened condition d/t restraints and the inability of moving freely. Had they been allowed to move freely would they have fallen who knows but I have had residents beg to get out of restraints. Who are we doing a favor with restraints, STAFF? family, at times yes, the resident, rarely.

I will rarely agree to having residents restrained. When I'm in charge it is only the extreme cases that have restraints. I have found that many times allittle explaination to even those who are confused will aid them not to go to those WRONG spots.In some cases locked doors, low beds(the type that adjust), and a good exercise program, implimented by OT and activies will help residents to keep moving safely, front closing belts are also okay, and not considered restraints as residents can open them.

Good luck with what you are trying to do, politics are never fun! But your heart is in the right place. I went to a great inservice on Alzheimers many years ago, Len Fabiano spoke on restraints he spoke of a son who wanted his father restrained as he was afraid of him dying from a fall. His father spent several months fighting with the restraints many times falling and then not long after died d/t restraints. The son said well I was afraid of him falling.

WELL, I guess he really didn't have to worry about that once his dad passed!?

Possibly some well placed articles on the ward for resident families to see would educate them on the debilitating affect of restraints.

Health and safety committies and administration.

Anyone with a like mind, no matter their designation.

Good luck, and God bless you.

tinkle · Jul 21, 2006

I agree that some residents r/t their disease process cannot process that even though they walked their entire life upto now without falling that they cannot do it anymore, safely. I also agree that some restraints could be used for safety. But the states and federal system had to institute some kind of guideline to keep residents from being restrained unnecessarily. And it did start years ago when the states were pressured to keep residents safe. However, I think it is way out of proportion now, and it is hard to keep them safe. You can careplan and document with the ID team and get restraints with in reason for specific residents but it has to be documented with a full assessment and justification and a Drs. order.

Restraints are a big F-tag if not documented appropriately and used justly. Most managers just donot want to take the risk. tinkle

Daytonite, BSN, RN · Jul 23, 2006

this is a hot issue in healtcare. here are some websites of groups that are studying the problem and trying to find solutions that you might be interested in investigating. medicare will become directly involved in the issue when it involves medicare or mediaid beneficiaries. the idea is for facilities to do the right thing and work to solve these problems without waiting for laws to be passed. have you thought about doing some research on this and presenting evidence to your boss with suggestions on how to improve the patient falls in your facility?

http://www.cdc.gov/ncipc/duip/spotlite/falfacts.htm - national center for injury prevention and control. there are links here to facts about preventing falls, publications, statistics. click on "falls and hip fracture among the elderly" under fact sheets for information and references on this topic. also, suggest you explore the links under the tool kit for more information on preventing falls

http://www.macoalition.org/documents/restraintprojectbackground-overview.pdf - massachusetts coalition for the prevention of medical errors: best practice recommendations to improve patient safety related to restraint & seclusion use. http://www.macoalition.org/documents/restraintprinbestprac-definitions-final.pdf - this is the site where they list their conclusions regarding principles to improve patient safety related to restraint and seclusion use.

http://www.charlydmiller.com/lib05/1998hartfordinvestigation.html - deadly restraint: a hartford courant investigative report on the death of an 11-year old patient in a psychiatric hospital from restraint asphyxia. this is a complete report of the investigation.

http://www.charlydmiller.com/lib02/1998jcahoalert.html - jcaho sentinel event alert paper on preventing restraint deaths. includes strageties for reducing risks.

http://www.charlydmiller.com/ra/ralibrary.html#hartcourant - restraint asphyxia library. a list of links to information about restraints and asphyxia related injury.

http://www.mywhatever.com/cifwriter/content/66/4376.html - oregon restraint reduction project.

http://www.patientsafety.com/links.ps.html - patient safety. links to information about patient safety. includes falls.