Restraining patients

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.)

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

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

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.

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.

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

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...

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!

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}}}

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

Originally posted by rhona1

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

I would, too...But when you have the ETOH positive CHI with BLE Fx's in traction pulling everything out and trying to get out of bed and walk home, the restraints don't seem so dehumanizing. Sitters are great if you can actually get one. :)