Restraining patients

[LinnetLegs]

I have been asked to look at our hospital's policy regarding restraining patients (I am one of a group of people who have been asked).

I wanted to ask everyone their views on restraining patients and what your local policies are.

Any advice or information would be greatfully received.

[BBFRN, BSN, PhD]

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. :)

[nursekac]

I work in a state psych. hospital. We define 2 types of restraints - psychiatric (for the purpose of modifying behavior) or medical related. I know the general trend is to be least restrictive. This is certainly a challenge with on-going staff shortage and lessening of other resources. We have a number of mandates placed on us by human rights statutes which are very explicit as to supervision, assessment requirements, even training of staff implementing restraints.

LinnetLegs - see PM

[Nebby Nurse]

Restraint free policies are a fine idea on an adequately staffed unit but in my experience it is not always a good thing. And I'm not talking about posey vests and wrist restraints. Have you ever arrived on the unit in a long term care facility to find side rail orders DC'd on your agitated dementia 90+ year olds? No fall matts and hard floors. One nurse-you, and two CNA's working short? Geri chairs with tray tables are a thing of the past. Haven't seen a criss/cross belt for a while either. What good is a chair alarm when you're in the middle of an emergency? And you just gotta love the agitated demented aggresive ones in the merry walkers where no resident nor their belongings are safe from harm. But of course it is a resident's right to fall and be free from restraints. And we nurses will continue to pick them up, send them to the ER and generate the incident reports.

[BBFRN, BSN, PhD]

Originally posted by Nebby Nurse

But of course it is a resident's right to fall and be free from restraints. And we nurses will continue to pick them up, send them to the ER and generate the incident reports.

And the irony of this is that they more than likely will be restrained in the ER.

[deespoohbear]

1:1 is great, if you can get the staff. A lot of times that is not possible. So what are you suppose to do? Restrain the patient and risk injury from the restraints, or let them go and pray they don't fall and break a hip or run off from the unit? Kind of stuck between a rock and hard space. The one thing that really gets my goat is when the therapy dept comes up and tells me how to care for my pt. I had one little old lady that we tried EVERYTHING before finally putting her in a geri-chair with a tray. We did bed alarm (she just unclipped it from her gown), a roll belt (which she promptly removed), a lap buddy (also removed), sitting her at the desk (she walked off). Finally I put her in a geri-chair with a tray. Her family refused to come and sit with her and I had 9 other pts that day to care for. Occupational therapy came up and reamed me a new one because I had put her in a geri-chair because it was the most restrictive restraint. She suggested the lap buddy, roll belt, and everything else that I had already tried. After a heated conversation I finally told the therapist that if she wanted to she could take the pt, put her in a w/c with a lap buddy and take her TO therapy with her to watch. Funny, she didn't take me up on my offer.

I don't agree with restraining a pt without trying other alternatives first but occasionally you have to make a decision about which is the lesser of two evils: being restrained or falling a busting a hip or something else.

[Inza Boone]

My husband was in the rehab and had to have a foley catheter put in. He was fine until after he was in the bathroom and was taken care of and was put in the wheelchair by the bed. They hooked his bag with the urine in it over a hook under the wheel chair at the back and he stood up and the tubing was too short and it pulled the foley catheter out of the bladder and tore the tissue and he was on Coumadin and bled out when he stood up and stopped breathing and never got a pulse to take him to the ER. He had a stroke on June 30th.His death was August 29th. Received the TPA and was raising his arm over his head in 3 hours. He had 1000,cc of urine in the bladder and had the catheter about 3 weeks before he passed away. I tried to get him restrained and they said they would lose their license. He had fallen out of the wheel chair two times on the third and fourth day after he was admitted to rehab and was found at the foot of the bed the first night on the floor after he was admitted to Rehab probably trying to go to the bathroom because of the residual urine we didn't know he had at that time. The little guard rail was not to the half of the bed. Who made the law to not restrain patients who have had a stroke? He rolled himself to the nursing station with his feet and hands the morning that he had passed away at 2:15 p.m. He was talking and joking with the nurses. He had a good week end. I have heard it was a Federal law and also State Law to not restrain. Who is responsible for this. I am a R.N. who graduated in 1947. My husband was a WW11 Veteran and spent a lift time after returning from the South Pacific in 2 months he was admitted to the hospital and received 125 shots of Penicillin with Fever and chills after each shoot. They didn't know what was wrong and the diagnosis was Tropical fever. He was then put on Streptomycin, went home in two weeks to come back with ruptured ear drums and took short term pcn. He went home and came back to the hospital to have his tonsils out. We were married in 1948 and were doing well for awhile. In 1986 he had breast cancer and had to have surgery. He was sprayed with DDT in the South pacific every week for 24 months and are they linking pesticides with cancer now? He had Surgery for an aneurysm in the lower Aorta in 1995. He survived even though they poped the Inferia venacava off the Heart and put it back on with 2 units of blood before we ever had Heart surgery in our hospital. The doctors said that he had brittle intestines and more colaterol blood vessels than he had seen in any abdomen. Six months later he had to have a Colectectomy except they saved a foot of colon. It was bleeding diverticlums with blood pressure 50/30 when he passed out. He had systemic E-Coli and did not remember 2 weeks very much and was fed Subclavina and received 23 units of blood. They were going to send him home the 24th day and did lab work and he stayed two more days because his white count was 19,000. He had his left knee replaced in 1997. 1998 he had Heart surgery, 5 blocked vessels and 4 were bypassed and he did well. I was checking his Blood Pressure and found his pulse was 32 six months later. He had a Pacemaker six months after his heart surgery in 1998. Pacemaker exchange was done in 2003, another pacemaker exchange in 2009. I forgot he had Acid reflux in the eighties and regrugated and aspirated sat up and stopped breathing at 12:45 a.m. I pulled him off the bed and put him across my arm and pusjed his head down and beat his back and he started coughing and I kept beating him and he stood up and went to the bathroom. I said we need to go to the ER and he said for what. I said you stopped breathing. He said I am breathing now and wouldn't go so I watched him breath till 5:oo a.m. and told him I had to get to sleep I had to go to work at 1 p.m. I did take him for a physical and he said he didn't remember any thing so the doctor said. We have been blessed with 63 years of Marriage July 22, 2011 and celebrated it in another Rehab at lunch because a pipe had bursted and we went back to the other Rehab after one night in the new rehab. I just want this to not happento someone else. Even me because I was 15 years from 100 Sept 9,2011 and I couldn' stay with him this time the only one I missed. Thanks for listening.

[tiroka03, LPN]

I am not against using 1:1's. However I don't think it is always the best solution. You are putting untrained staff in a very dangerous situation.

How would you do in a small room containing yourself and a 250 man with DT's. What would you do when he becomes violent and your are struck by him? I think the 1:1 staff should be guards and policeman when the patient is violent.

What would you do in a pscyh ward watching a person who is trying to escape, and is on sucide watch? They can turn ugly fast. I have seen staff and nurses injured to the point they can not work again.

Don't we care about staff safety?

The makes me madder than H E Double toothpicks

[LaterAlligator]

When I worked in a dementia facility, we were restraint-free. The closest you could do was put someone in a recliner so it was a little harder for them to get up and fall. At the hospital where I work now, we can have restraints under certain circumstances, and with lots of checks and documentation. I love it. I feel so much safer working somewhere where the person who wants to choke me cannot get to me and hurt me anymore. I don't think we should restrain people for no reason, but if it's necessary for their safety or my safety, that's a good reason right there.