Restraining patients

BrnEyedGirl, BSN, MSN, RN, APRN · Nov 20, 2008

Wow,.that's kind of a broad question. I work ER and restrain pts every shift I work. It depends on why they are "uncooperative". If it's a trauma pt that's trying to remove IV's and tubes we try to sedate them, if it's someone under the influence of drugs/ETOH we call security and often sedate as well. We have security 24/7 so they are usually around to help if needed. We do have written protocols on restraints, frequent checks on pt, toileting, etc.

classicdame, MSN, EdD · Nov 20, 2008

If you keep in mind that restraining is for the safety of the patient and others, then you can make better decisions. Do what it takes to make it safe. I highly recommend you NEVER attempt to restrain anyone by yourself. That is a good way to get injured, or injure the other person or be involved in ugly legal stuff.

madwife2002, BSN, RN · Nov 20, 2008

Unfortunatly yes

suzy253, RN · Nov 20, 2008

Unfortunately, I've had to restrained many confused and agitated patients who kept pulling out their own medical equipment, trying to get OOB without assist (fall risk). Sometimes we have no choice, failing all other options....bringing the patient to sit outside the nurses station, etc. Just have to follow the protocol even if it means more paperwork!!!

THAT Nurse., MSN, RN, APRN · Nov 21, 2008

Our facility is moving away from restraints, all restraints. They would rather have a sitter with the patient 24 hours a day. We rarely use restraints at all anymore. I have not seen them used in months.

CABG patch kid, BSN, RN · Nov 21, 2008

Hi everyone,
Just wondering if you've ever came across an unco-operative patient that had to be restrained. What happened? How did you respond? Is there a procedure you are allowed to use or do you call security?
Thanks in advance for sharing your stories!
T123G123

I think all of us have been there at one time or another. There should be a policy in place as well as state laws regarding restraints. For example, in my facility we can place restraints without an order if absolutely necessary for patient and/or staff safety, but must get a doctor's order ASAP. A restraint order is only good for 24 hours and then it must be renewed by the MD if restraints are to be continued. Also, a PRN restraint order is illegal, the doc can't just write "restraints PRN" and have it be... they have to reassess the need for restraints every 24 hours and then renew or d/c the order.

Also, we are leaning away from restraints, our facility would prefer a sitter for those who are confused and try to get out of bed, but I think restraints are still used mostly in ICU because you can't really have a sitter for every intubated patient, nor would it be safe because people can extubate themselves quite quickly if not sedated enough.

Overall, you have to look at each individual patient and determine what is best.

loriangel14, RN · Nov 21, 2008

I have to deal with uncooperative pts on a daily basis.We can restrain without an order if they are a danger to themselves/others. POA can sign for permission to restrain but we frequently get PRN orders for chemical restraints as well and use them as needed.

EarthChild1130 · Nov 21, 2008

Yep, had to restrain many a patient...usually if they are danger to self or others. As has been posted, places have policies and procedures in place for dealing with application of restraints and maintenance of a patient who is restrained.

My piece of advice would be to have a plan of action, and if at all possible, try to de-escalate the patient as early as possible with meds, time-out room, etc...many a night a patient on our unit ended up in restraints when s/he could have very well been de-escalated earlier in the night.

mskate · Nov 21, 2008

where i work, if you have an ett. you get restrained until you are off all meds and can prove to me that you are calm, completely with it and will not pull at anything or do anything that might get your hand caught in my lines or ett. if you end up pulling something out, you get tied down.

i have had some patients who have become markedly violent, i call security, sedate and then restrain. sometimes, its just the nurses laying on a patient. and although this is unethical, there have been several charts i've seen where a patient comes into the trauma bay and gets "intubated for beligerance". (yep - in those words - right in the progress notes! the thought being, if you came in and you are a trauma, and you are heavily intoxicated, you MIGHT have hit your head and we have to do scans and if you are acting like this, we cant, but you cant show your competency, so you are tubed.)

chemical and physical restraints are quite common in the icu. security can happen, sitters are rare if not completely unheard of.

Aneroo, LPN · Nov 21, 2008

I think almost all of us have.

Due to legal issues, most places try not to do restraints, and you should document everything you have done prior to restraints (to prove you did what you could to keep from having to go as far as restraints). Whether it's increased watch, moved their room, distraction with tv or activity board, bed alarms, whatever- document it.

There should be a policy/procedure in place. If not, RUN. LOL We had two sets- one for behavioral and one for medical. Medical had to be renewed every 24 hours, q2hr checks, and was used for the confused person pulling out lines, demetia pt thinking they're going home but they're going to hit the floor as soon as they get out of the bed- that sort of stuff.

If it was a psych patient, drunk person, someone who was not able to make an informed decision for their own care at that time, who was aggressive and combative, etc- they got behavioral restraints. Same restraints, a whole lot more paperwork. You still have to document offering toileting/food, pulses, etc, but you still have to check them more often, and the order has to be renewed more frequently.

We had restraint orders for children, but we never had to use them, thank God.

Cops- it depends. At the larger hospital I worked at, they used to be able to throw some handcuffs on them and that helped a lot. JC didn't like that, and we needed IVC paperwork before we could do that anymore. Of course, if a patient was coming after us and was getting ready to harm us, they would step in and help, but it really limited their role. If a patient had current IVC (involuntary committment) paperwork, our cops or local cops would be there, and they could use their own decision making as to whether or not they wanted to use restraints. Usually they did, and would handcuff an arm and leg to the bed rails.