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.

[Red Kryptonite]

When I worked in the hospital here in AZ, abusive intoxicated patients were certainly put in restraints, and not just in the ER.

[akulahawkRN, ADN, RN, EMT-P]

Restraints can be put in place to provide for patient safety. The thing is that once you place someone into any kind of restraint, you also must implement much more frequent monitoring to ensure their safety while restrained because you have taken away much of their freedom of movement. Over the years, I have placed hundreds of people in restraints, usually 4 point. I don't worry about my own safety, nor would I normally restrain someone purely for my own safety. That being said, if someone is willing to hurt me, they're also willing to cause some significant self-injury/harm.

The vast majority of people I have placed into restraints were people on psychiatric holds and most of the people on holds did not require restraint. It usually was quite obvious which patients required restraints.

[Nurse Beth, MSN]

4 point restraints may look/feel disturbing if you've never seen them before. But assuming the hospital is using them appropriately, then they are really protecting the patient from harm (or others from being harmed by the patient).

[azhiker96, BSN, RN]

I'm surprised nobody has mentioned a social intubation. Sometimes you need to take the pt to CT to check for a physical reason for inappropriate behavior and they need to be still for a good scan.

[TransportJockey, EMT-P]

I'm surprised nobody has mentioned a social intubation. Sometimes you need to take the pt to CT to check for a physical reason for inappropriate behavior and they need to be still for a good scan.

Happens with rotor crews too. With a patients feet right by controls, you dont want a combative patient that's concious.

[Rose_Queen, BSN, MSN, RN]

I'm surprised nobody has mentioned a social intubation. Sometimes you need to take the pt to CT to check for a physical reason for inappropriate behavior and they need to be still for a good scan.

We call that a therapeutic intubation. Mainly used for traumas, many of which have some substance on board.

[Fancypants09]

Mechanical restraints CAN be abused/used improperly and pt can be restrained for unnecessarily prolonged period of time, doesn't necessarily mean they ARE being abused.

Not much else I can say that hasn't already been voiced, but I will add my 2 cents worth of experience. The psychiatric facility where I'm preceptoring has a 'Least restraint policy' and a trauma-informed view of care, and I've actually yet to see mechanical restraints being used. I see seclusion used and PRNs given (like loxapine, olanzapine, etc) and those alone are effective. There is also de-briefing form that is mandatory to be filled out by patient after restraint use.

[JustBeachyNurse, LPN]

There are many regulations and policies for safe use of restraints and are highly regulated throughout the U.S.

[JustBeachyNurse, LPN]

Chemical restraints were necessary for the safe rotor transport to an appropriate higher level facility as my father's intractable seizing and posturing from a ruptured aneurysm. The helicopter would have crashed if they could not use physical & chemical restraints. I could not sign that consent fast enough!

(Never leave a SAH or any other ICH patient flat once the scan is done! )

[NRSKarenRN, BSN, RN]

Thread closed post Admin review as members provided excellent advice.