restraining on a nurses order?

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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.

Specializes in General adult inpatient psychiatry.
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".

No PRN orders in Psych. That's why we have telephones and VTOs and doctors on call. With restraints and seclusion on my unit, someone (an MD) needs to face-to-face see the patient within the first hour, sign the order and then we're good for another 24 hours for an order.

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Specializes in General adult inpatient psychiatry.
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".

To hold a patient down isn't technically considered restraints...it's more short term than that. It's usually until the patient can be given PRN meds or the situation otherwise de-escalated. I can see where you wouldn't need an order, even a PRN for that. This is about safety of the unit in the immediate sense.

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So using force isn't technically a restraint, only the use of chemicals,straightjackets, are considered restraints,right?

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What about using force for 10 or 15 minutes?

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Specializes in General adult inpatient psychiatry.
What about using force for 10 or 15 minutes?

That's something I would typically say depends on your policies and procedures manual, but I'll see if I can't find more information for you on the subject.

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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".

NO prn orders in psych or anywhere else. If you need to restrain someone, you (the RN) initiate the restraints and get the physician order ASAP after initiating the restraints. NO prn orders, NO standing orders. Each incident requiring restraints is treated as its own, separate, individual emergency -- no matter how often a particular client needs to be restrained.

The actual "format" of the restraints ("leathers", jackets, physical holds, etc.) doesn't matter (beyond what is legally allowed or not allowed per your state regs and facility policies) -- the same rules about physician orders, etc. apply, regardless.

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To hold a patient down isn't technically considered restraints...it's more short term than that. It's usually until the patient can be given PRN meds or the situation otherwise de-escalated. I can see where you wouldn't need an order, even a PRN for that. This is about safety of the unit in the immediate sense.

So using force isn't technically a restraint, only the use of chemicals,straightjackets, are considered restraints,right?

What about using force for 10 or 15 minutes?

I worked as a psych surveyor for my state and CMS (the Medicare/Medicaid agency -- if your facility takes Medicaid funds, you have to abide by their rules) for several years, and can tell you for a fact that the CMS rules, my state, and, probably, every state, defines "restraint" as anything that restricts a client's free movement, regardless of whether it's a restraint like leathers, a jacket, or a geri chair with table, or a physical hold -- if you're keeping them from going where they want to go, that's a restraint, regardless of how you do it. (For that matter, if you put someone in a room without a locked door but prevent them from leaving the room by standing in the doorway or holding the door shut, that's locked seclusion by CMS standards, even though the door isn't actually locked -- the fact that you're keeping them from leaving the room is what matters, regardless of how you do that.)

Also, you'll want to check your own state's rules, but for CMS and my state, there's no minimum time before it becomes restraint -- according to CMS (and I know this for a fact and have cited facilities for this), if you have to hold someone down to give them a shot in an emergency situation, even though it only takes maybe a minute to give the shot, you are expected to get an order for the restraint, do the LIP face-to-face evaluation, etc. It doesn't matter how short a period of time it is you restrain someone, it's still restraint and needs to be treated like any other restraint episode.

You may want to consult with your state dept. of mental health and the state agency responsible for regulating your type of facility if your facility isn't doing this ...

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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".

Wow! That is very frustrating that you can't use anything like maybe pillow to his head while he is banging his head on the floor to protect the poor kid from hurting himself. they need to do something or have some protocol in place incase the client were to have that behavior happen again! ******-off.png

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