4 Point Restraints in the ER. Is that Abuse?

[Vickymay]

Just started work as a RN nurse in the ER in LA and some drunken patients are put in 4 point restraint. Another elderly man was also in wrists restraints. Is this abuse? Since the hospital in Arizona where I worked before which was a different state from California did not do this.

[MunoRN, RN]

The use of restraints need to be for a valid purpose (to facilitate treatment, to protect the patient, to protect staff, etc) and the least restrictive form of restraint that is still effective needs to be used and only after less restrictive measures have failed. If those requirements are met, why would that be abuse? There are many situations where alternatives to restraints will work just as well, but not always, how would things like the safety of the patient be protected in situations where no alternatives are effective?

[JustMeRN]

I suggest you ask for more education on your facilities restaint policy. Or try looking it up. Restraints used appropriately are not abuse. Restraints are (or were at one point) a jcaho issue, any accredited facility should have a policy.

[Morainey, BSN, RN]

They may be in restraints for injurious behavior (ex: with potential to harm themselves or others) or to prevent interfering with care (such as a confused person pulling at medically necessary interventions, like IV lines, Foley catheter tubing, or NG tubes, just to name a few). Your facility should have a policy on this which clearly defines when restraints are indicated.

[Altra, BSN, RN]

I'm assuming you are in your orientation period since you stated you just started this position. If you have not yet been over restraint policies and practices with your preceptor, please ask for this education.

Are you saying that restraints were never used in your previous place of employment, and you are unaware of their appropriate clinical use?

[Vickymay]

Are you saying that restraints were never used in your previous place of employment, and you are unaware of their appropriate clinical use?

Well--No they were not.

[Vickymay]

The use of restraints need to be for a valid purpose (to facilitate treatment, to protect the patient, to protect staff, etc) and the least restrictive form of restraint that is still effective needs to be used and only after less restrictive measures have failed. If those requirements are met, why would that be abuse? There are many situations where alternatives to restraints will work just as well, but not always, how would things like the safety of the patient be protected in situations where no alternatives are effective?

That's a strange comment.

[EmergencyRN22]

That's a strange comment.

Thats a strange response to a well spoken answer addressing your question.

Check your employee manual as well - good practice to be very familiar with your employers policies and protocols.

[Guest219794]

That's a strange comment.

What is strange about it? It's clarity, or its accuracy?

[AnnieOaklyRN, BSN, RN, EMT-P]

If the drunk person punches a nurse, is that abuse?

If a demented patient grabs a nurse, is that abuse?

Annie

[TheCommuter, BSN, RN]

That's a strange comment.

Your title indicates you are an RN and a certified nurse midwife (CNM), yet your user profile indicates you are a pre-nursing student. Which is it?

I would expect an advanced practice nurse such as a CNM to have a wider breadth of knowledge on simple issues such as restraints. After all, CNMs are educated at the master's degree level. It is also unusual for CNMs to work in emergency departments as staff nurses.

Be mindful that members are not permitted to claim they have degrees and licensure that they have not yet earned.

[JBudd, MSN]

4 points are used when a (usually intoxicated or high) person is out of control, usually demonstrated by trying to hit/bite/kick/grab/spit on staff, or being unable to be safe when left alone (getting out of bed when too drunk to be able to stand). No it not abuse, it is maintaining pt and staff safety.

Our 4 points usually then get sedated, and as soon as they are "out" (chemically restrained), the physical restraints are removed. As others have said, there are very specific guidelines that must be put into facility P&Ps; which include close observation and charting on such things as circulation distal to the restraints. Also, MD must evaluate in person and sign off on restraint orders.

(and.... "RN nurse" is repetitive, as RN means Registered Nurse)