restraining on a nurses order?

caliotter3 · Feb 21, 2010

You better find out. Sure sounds fishy to me. Call the State, they would most likely be the ones who would be citing the facility if it is wrong. I see trouble here if you don't find out the rules of the game.

HM2VikingRN, RN · Feb 21, 2010

jcaho calls for lip orders to initiate restraint. The RN can renew the orders but the rerenewal must be based on LIP assessment. http://www.jointcommission.org/AccreditationPrograms/BehavioralHealthCare/Standards/09_FAQs/PC/Restraint+_Seclusion.htm

They are incorrect if they claim a provider order is not needed for 24 hours.Pragmatically a patient can be restrained pending assessment by the LIP but the orders must be written in very short order.

cherrybreeze, ADN, RN · Feb 21, 2010

I wouldn't think a standing order would hold water, either...then you could feasibly also restrain anybody, without proper assessment by MD or midlevel provider. Our restraint policy states no PRN orders for restraints, and a standing order would be even worse than that.

smartnurse1982 · Feb 21, 2010

So it means I have to call the doc before restraining even if a client is banging his brains out on the floor? So there can be no prn oderd for a restraint?

cherrybreeze, ADN, RN · Feb 21, 2010

so it means i have to call the doc before restraining even if a client is banging his brains out on the floor? so there can be no prn oderd for a restraint?

you can restrain and then get the order. but no, no prn orders. the situation that requires the restraints needs to be assessed at the time they are required. a surgeon can't write an order, say, for restraints prn on a patient that is normally a&o, in case they decide to pull on their lines (we have one surgeon that has this on his standing orders, but we cannot use it). if there is enough of a change in the patient's mentation that they now need restraints (let's say it's 2 days post-op), the doc needs to be called and made aware. you can put them on, but if you call and they don't order them, you take them off, that's all. you figure out in time which docs will let you have them and which ones won't (but you call regardless).

they said even if we restrain a client we don't have to get an order within 24 hours. this statement is from your original post, and this is what i am referring to...that's what i mean by, you can restrain, then call. we have technically 24 hours to get that order (it's different for leathers, but i don't work in a unit so that's a non-issue for me). we just would never actually wait 24 hours to do it, usually the situation is enough that we'd be calling and wanting them to know, even if it's the middle of the night. restraints are such a touchy issue, and can potentially be a very litigous one, so i wouldn't ever be comfortable using them without the physician knowing...that leaves my butt completely on the line and out in the open, and i don't roll that way. :lol2:

shannonFNP, BSN, MSN, RN · Feb 21, 2010

Restraints *CANNOT* be written as a PRN order, so that would include standing orders as well. You can restrain a client while someone contacts a doctor. The order must be signed within 24 hours of you writing the TO.

PMFB-RN, RN · Feb 21, 2010

So it means I have to call the doc before restraining even if a client is banging his brains out on the floor? So there can be no prn oderd for a restraint?

*** Of course you can restrain him in that case and no you can't (or darn sure shouldn't) have PRN restraining orders. You restrain him while another staff member makes the call to the doc. If there is no other licensed staff member to make the call other than you, you restrain and the instant it is safe for you to do so you make the call.

smartnurse1982 · Feb 21, 2010

No prn orders in psychj either? The way they retstrain in this facility is by using two staff to grab each arm of the client.they don't use mittens,jackets,or anthing,just "force".

PMFB-RN, RN · Feb 21, 2010

Hello just a quick question. I am contracted to work in a pediatric ptrf. I'm trying to figure out of its more like hh or ltc. The past 2 days of orientation that I did seemed to me like hh. Also they said we can tell the mental health techs to restrain a client without a physician order. They said even if we restrain a client we don't have to get an order within 24 hours. All that sounds iffy to me. Can I tell the director we need standing orders for a restraint? They were a group home but upgraded to a ptrf and I am the first nurse ever to work there.

*** What are "ptrf" and "hh"?

smartnurse1982 · Feb 21, 2010

Psychiatric treatment residential facility and home health

cherrybreeze, ADN, RN · Feb 21, 2010

No prn orders in psychj either? The way they retstrain in this facility is by using two staff to grab each arm of the client.they don't use mittens,jackets,or anthing,just "force".

Well, that changes things, but I wouldn't know how to answer the question. That isn't what came to mind for me (or seemingly anyone else) hearing the word "restraint/restraints." I don't know what kind of policy would be needed to physically, forcefully hold someone down. In my work environment, it rarely happens. On the rare occassion there is a patient that is combative, we'll hold them down to a point (like holding legs if they are kicking as you are trying to do something with them) but other than that, we just get out of the way. You can't really have/get a doctor's order to hold someone down if it's necessary. However, if it's something that you would find yourself needing to frequently do with the same patient, restraints such as wrist or chest restraints would obviously be necessary, and then the above advice comes in to play.