Patient face-down ok?

[Floor_Nurse]

I recently observed a family member turn a patient (relative, a young adult who cannot sit upright without harness/straps) face-down because of behaviors. In the prone position, he can't flail his arms and legs much. Way back when I was a CNA, I was taught never to put a patient in the prone position. Is this harmful?

[ruby_jane, BSN, RN]

Depends on a number of other factors. Could be if there's a breathing issue or if the patient is obese or on medication that would cause him to be excessively sleepy...and that's just a few things off the top of my head.

Is the family member allowed to do this? Is it on a unit or is this home care? Did you document?

[brownbook]

If the family has been doing this for several months or years and the patient tolerates it, maybe it's okay. But there may come a time he doesn't tolerate it as well.

Can he lift his head, turn it side to side while prone?

Is someone frequently checking on him while prone?

Why does his flailing need to be stopped?

[Davey Do]

A patient should NEVER be restrained face down, as it inhibits respirations.

I know of two patient deaths which were directly contributed to face down restraints on the floor.

[brownbook]

You're right as usual Davey Do. The poster didn't give many details. I have no idea if they are using restraints when he is prone? She just mentioned harness/straps to support him when he sits upright.

[Floor_Nurse]

In response to ruby_jane: The answers to most of your questions are yes. This is a patient (not obese) being cared for at home. The behaviors are violent at times, as he kicks and tries to bounce his body up and down enough to fall out of the bed. I mentioned harness straps for when he's in a car seat, as he will fall over without them. There's no tie-down restraints of any kind, nor mittens, nor Lorazepam. He can turn his head somewhat. It's unclear as to what is causing agitation / pain or discomfort. I no longer go into that home to do nurse visits. I cannot risk my license because of the decisions/actions of family members.

[JKL33]

On 2/19/2020 at 9:12 PM, Davey Do said:

A patient should NEVER be restrained face down, as it inhibits respirations.

I know of two patient deaths which were directly contributed to face down restraints on the floor.

Ignorance on my part: Can you clarify whether you're referring to additional restraint (manually by another person or via device) or are you referring to the prone positioning itself as the restraint? Thanks.

[Floor_Nurse]

Well, that's a good question... a restraint in sometimes classified as something or (someone) that inhibits or restricts the movement of a patient so that they do no have freedom of movement. If you hold someone's wrist tightly for an extended period of time, that's a restraint. In a court of law, this face-down positioning may get a nurse in trouble because the patient cannot turn over by himself. Besides legal trouble, my concern is with the adverse effect of decreased respiratory function. Thanks for all your responses.