Pt found dead!!!

mother/babyRN, RN · Nov 18, 2003

Thats why however busy we are we still take the time to complain, and fill out an unsafe staffing report that we file and give a copy to the supervisor...The union doesn't like those piling up, and neither do the lawyers for the hospital when a suit comes up for review and eventual settling...

glascow · Nov 19, 2003

Originally posted by New CCU RN
Thank you for updating us... it opens people's awareness and perhaps will make us all think before we go to use restraints next time. However, I wonder if it is right to be posting such a topic on a public bulletin board. Personally, I would be very weary of being public about such topics...you never know who is reading this board.

I actually thought this was the perfect place to post this. I did not include the hospital name or City. I also believe that the public needs to know that the hospital is NOT a safe place to be.

Several nurses have responded to this post saying this was an eye opener to them, perhaps lives will be saved.

Does anyone else thing this shouldn't have been posted here?

HeartsGalore · Dec 2, 2003

In my hospital,for all restraints,we must have a Dr's order for the specific restraint and must complete a checklist on the pt EVERY 15 MINUTES!! You must also indicate on the form whether the family is aware and list the other measures you've initiated before resorting to the mechanical restraint. As you can see it's hugely time-consuming,but I'm guessing that it's this way because the hospital likely has had something catastrophic happen in the past. I just don't know how this would be workable on the floors, where the RNs have up to 6+ pts/shift:eek:

chris_at_lucas_RN, RN · Dec 2, 2003

At our hospital, we have sitters and we have restraints. The restraints are Posey brand, but they are ankle and wrist only. There is no possibility of climbing anywhere.

They are cheaper than the vests as well.

Have seen the vests, seems if they are properly attached to the bed, this climbing out should not be possible. Nor should strangulation.

It does appear that the real issue is lack of safety due to lack of staff.

And as for the appropriateness of the post, I wouldn't let one person's opinion bother me. Yes it's a public forum, and good for that! Already too many secrets that cost people their lives and health.

Personally, I don't think there would have been anything wrong with mentioning the location, either, but then, that's me.

(Okay, no fights with me over that last bit, please. The thread is about patients paying the price the hospital is unwilling to pay for safety....)

stevierae · Dec 6, 2003

Originally posted by Vsummer1
The hospital I go to clinical in does not use posey vests (not sure if illegal or just hospital policy).

If you put a patient in physical restraints, you must document every 15 minutes! That basically means a sitter anyway.
They take protection of patient AND staff VERY seriously here, and now I understand why!

Yes, that's what I have seen as the trend when I was treaching in various hospitals nationwide over the past year or two--they had VERY strict restraint protocols: most of those patients, were confused anyway, so had sitters; the restraint orders had to be reevaluated and rewritten every 24 hours, and some hospitals had orders that required that the restraints had to be released at specific intervals--as stated above, often every 15 minutes--, skin and patient assessed and findings documented, then reapplied.

kc ccurn · Dec 11, 2003

Restraining patients for their safety has become a very hot topic. I believe it is one of JCHO's newest projects. At our hospital I work in ICU, we have to have a signed order q 24 hrs by the MD for restraints, whether limb restraints or posey, and if side rails are up x4 then we have to have an order for that as well. We do use posey's but, as most posey's should be, they only have the strap to secure to the bed at the waist, in the good ol' days there was a strap at the top of each shoulder that secured the pt's shoulders back to the top of the bed but that design changed because the Houdini's tried to slither out the bottom and would choke themselves.

Restrained patients do need to be observed very frequently, even if they are in wrist restraints, it amazes me how patients can work their way out of wrist restraints as well.

As far as sitter are concerned, it's a catch 22. Frequently I've had to wake up the sitter as I went into my restrained patients room because he was climbing OOB. We don't use sitters any more in the CCU, but the floors do.

I'm sorry to hear about the patient that died. It does happen. I think it is equally sad that the nurse that this happened to received no support, emotionally or professionally from her manager or hospital. That is very sad!

etmx5313 · Dec 11, 2003

At our LTC facility, we have absolutely NO restraints. We had a resident die from getting her head caught in the side rails. The nurse treated it like a natural death--didn't report that the woman was hanging by her head! Never did get any discipline on her license, although she did get fired. From that night on, all of our side rails were zip-tied to the frame and if any side rails were used, you were fired on the spot--but now we have all new beds--w/o side rails. Many families just don't understand why their loved one can't have side rails. You try and explain but people don't understand that it actually happens.

kc ccurn · Dec 11, 2003

How do you keep your patients from fallling OOB?

Skate · Dec 11, 2003

My God, your worst nightmare come true... My question is where was the physician or physicians? I had an agitated pt once who had just had cardiac cath... He spoke Russian however understood simple instructions. While I was attending to another patient in another room he got up and fell.... Fractured a hip....

Afterward the nurse manager counseled me and suggested that if I ever had a patient like that again I should leave him by the nurses station or in the hallway so he could be viewed and watched by all. Not a total answer but something to consider...

Skate · Dec 13, 2003

In some long term care facilities to keep people falling out of bed they place the mattress on the floor...

germain · Jan 5, 2004

kc ccurn wrote

"As far as sitter are concerned, it's a catch 22. Frequently I've had to wake up the sitter as I went into my restrained patients room because he was climbing OOB. We don't use sitters any more in the CCU, but the floors do. "

I work as a sitter now in a large public hospital- I would be FIRED if I ever fell asleep at work. I read, surf the web etc, but only after I've buffed and polished my patient, and if tehy are asleep. I'm always sure my eyes are on the patient and I'm convinced its a great alternative to restraints, although sometimes I'm with restrained people. It cuts down on agitationto have someone to talk to, some diversion.,A nd makes the nurses job easier, at least I try.

Nothing is 100 percent, though. was with a patient the other day, holding one hand and STARING right at him by his bedside when- faster than lightening- he yanked out his NG tube. Just a blur and a gag and out it was. lukily the nurse saw, I'd hate to have tried to explain that one.

I alway thought posey vests were for use in a chair only, never in a bed. There is a trick to tying them correctly, otherwise they get too loose to be affective.

nursecompassion · Jan 6, 2004

I am not exactly sure what a posey vest is unless it is something I had seen in my stna class.

Does it kind of criss cross and then tie to the bed itself? just curious.

I know we don't use those at our LTC facility.