Restraining patients

Sleepyeyes · Sep 27, 2002

If someone needs to be in restraints we prefer to have them 1:1 with a sitter, but that's not always possible, so we have to get an order from the doctor verbally for each 24-hour period. We also have 3 different levels of restraint charting. Behavioral charting requires q15 min re-evals. Medical and protocol are for pt safety and require q2h evals with interventions such as repositioning, toileting, etc.

What I don't like is the vest restraints. I prefer if a vest restraint is used, that we have a 1:1 sitter, as patients have been known to hang themselves over the siderails and suffocate. I personally knew of 2 of these fatal incidents.

(Both were in LTC's and happened at night.)

RNIAM, BSN, RN · Sep 27, 2002

I would prefer to never see restraints. They are dehumanizing. If they are needed then they should only be applied as a last resort.

Sleepyeyes · Sep 27, 2002

Well, yeah, but when you have a pt. who's pulled out 4 IV"s and a PICC line, you're kinda outta options...

LinnetLegs · Sep 27, 2002

Thanks for that folks. I will check in again later to see any more replies. I agree it is a minefield when restraint is used.

We also have a duty of care. I think the 1:1 is probably the way our policy will go.

shannonRN, BSN, RN · Sep 27, 2002

one of the floors (rehab) in my hospital is restraint free. used to work there...could get tricky. we used a lot of bed alarms and had patients sitting by the nursing station frequently. the rest of the hospital requires a new order q 24hours...must document why when writing the order...RE: pulling out tubes. confusion doesn't cut it. we also have a standard form for patient checks...circulation, urination, h2o...we also must document alternatives such as hiding (camoflaging ) tubing, calling family, and reorienting...i'm off for a couple of days but i can get a copy of our forms and give you examples if needed. i'm pretty sure that everyone here will cover what i forgot!

restraints can be a good thing...when they are used for the right reason. we just had an incident where we had a confused, all spanish speaking patient. well, of course she wandered and most of the staff wanted to restrain her. thankfully, she wasn't. if the patient is intubated, vented...i think that is another story.

Mkue · Sep 27, 2002

I think restraints are necessary sometimes for patients safety and others. :)

BadBird, BSN, RN · Sep 27, 2002

I work in ICU and we restrain Vented patients, once the patient is awake and alert, if cooperative we remove the restraints. We document Q2hr/ and document when released, passive ROM, toileting, etc...

RoadRunner · Sep 27, 2002

Since May, we have a new policy at the hospital where I work. We have to ask for a written consent by the patient (!) or a member of his family to use restraints ......

I work in ICU, and let me tell you that this policy is a bit awkard for us! Chance is, there's a part in the consent form about using restraints without written consent if the patient puts his life in danger. Vented patients, with central and arterial lines, in ICU (they are not here for nothing, are they?), they fit the description!

night owl · Sep 27, 2002

I hate restraints b/c I've seen too many bad things happen when they were used. I prefer a 1:1. The most we've had on 1:1 at one time on my LTC unit is three residents. I always find it amazing that the supervisor ALWAYS finds the help for the 1:1's, but to find the help for the floor nursing, "I don't have anyone to send you" is always the answer we receive. PLeeeeeez!

Gosh, I remember way back before restraints had any regulations. It seems that every confused resident had a vest posey on. And still to this day, the laundry dept still sends a pillowcase full of vest restraints that no one uses and yet when we needed them years ago you could never find one! {{{sigh}}}

Long Term Care Columnist / Guide · Sep 28, 2002

I work in a "restraint-free" facility where, unfortunately, we seem to have a high proportion of family members who come in demanding side rails and other types of restraints, even after we explain the policy to them. I recently had one resident whose 71 YO daughter kept tying her into her wheelchair with a gait belt, and then called adult protective services on us because we refused to do this when she was not in the facility. (Frankly, the daughter was loonier than the resident.) We told the woman over and over again why this was not OK, gave her all the reasons why her mother would be in MORE danger of falls with restraints than without them, but to no avail. And I wonder just what it is people don't understand about the fact that a person has farther to fall if they go over the rails than if they just roll out of bed? That they can end up suffocating in a Posey vest or get trapped between the mattress and the side rails? Or that they are more likely to tip their wheelchair over on top of them if they are strapped in?

I also wonder why these folks don't realize how frightening it is for the restrained person to be unable to move, scratch their nose or even take a drink of water. I once woke up from anesthesia still intubated and restrained, and I freaked---I cannot stand being restricted in any way, and this induced sheer panic. I can only imagine what it would be like to be demented and confused on top of that---is it any wonder that some patients become combative??

The other problem I have with restraints is simple dignity. Unless one is going through DTs or some other situation in which there is a complete loss of control, restraints should almost never be used because they contribute to agitation, depression, embarrassment, and loss of self-esteem. IMHO.

shannonRN, BSN, RN · Sep 28, 2002

almost forgot..in my facility having all four siderails up is considered a restraint.