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Restraint Free Facility?!

Nurses   (1,137 Views | 16 Replies)

962 Profile Views; 16 Posts

We are soon going to be restraint free. And im a bit terrified. Our facility also lacks live sitters. I work on a PCU/tele/neuro/ICU holding floor. We typically have a sitter room that has 1 live sitter and 4 patients. And many times the sitter room is insane. 

Main concern is any sedation (chemical sedation) for my stroke patients. How is that safe?! Q 4 hr neuro checks on a chemically restrained patient...

And of course these combative patients that lose their minds every evening? The ones that attack their roomate? You want me to talk to them in a reasonable tone letting them know i understand their frustration...

If you are in a restraint free facility how do you handle it? Its possible; it happens at many hospitals. How do we keep our patients safe AND the staff safe. 

Please help!

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LibraNurse27 has 5 years experience as a BSN, RN and specializes in Community Health, Med/Surg, ICU Stepdown.

220 Posts; 3,246 Profile Views

OMG. I have never heard of this... All I can say is if my facility takes away restraints and doesn't provide a sitter for every single alcohol withdrawal patient we will have a TON of falls. Altered mental status plus ativan is a huge fall risk. It really doesn't sound safe to me. I hate putting patients in restraints and prefer to have sitters but usually we don't have enough, and some of our patients are huge strong men who are totally out of their minds on various substances. Sometimes restraints are necessary not only for staff safety but for patient safety. Is this a done deal or is there still time to give your feedback?

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LibraNurse27 has 5 years experience as a BSN, RN and specializes in Community Health, Med/Surg, ICU Stepdown.

220 Posts; 3,246 Profile Views

P.S. I would really love to never put dementia patients in restraints... so sad. I always feel like they should get meds to calm down if they are being aggressive and just a sitter if they are pleasantly confused, fall risk, elopement risk, etc. Restraints are terrible but I still feel like sometimes necessary. I hope you will update us on what happens.

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1,200 Posts; 8,058 Profile Views

This does not sound safe.  I’d get used to a ton of self extubations.  People are naturally confused when sedated.  When you wake them up for Neuro checks it sends them into a frenzy as they are scared.

I don’t think I could work there as it’s a huge safety issue.

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16 Posts; 962 Profile Views

Unfortunately it's a done deal. We were taken over by Cleveland Clinic and they are a restraint free hospital. Eeek!

 

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1,200 Posts; 8,058 Profile Views

2 hours ago, Verygreennurse said:

Unfortunately it's a done deal. We were taken over by Cleveland Clinic and they are a restraint free hospital. Eeek!

 

Have your higher ups explained how this is going to work?  Especially with vented patients?  Do you up their sedation and not do frequent neuros?  With frequent neuros they can’t be on a ton of sedation.  
 

But I would prepare for many self extubations.  Hopefully your RTs and pulmonologists are always close by.

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RNperdiem has 14 years experience as a RN.

1 Follower; 4,269 Posts; 29,956 Profile Views

Hopefully this will not become a case of blame the nurse for every fall, extubation, and elopement.

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TheLastUnicorn has 4 years experience and specializes in Critical Care, ICU, Rehab.

38 Posts; 117 Profile Views

I've worked in restraint free LTC/SAR settings... but never a hospital. I can't even fathom how that would work. I've seen a patient stick a fist through a fire door's window because he was high on whatever and in a rage; security was having trouble controlling him, a total of ten people couldn't get a hold of this and it took 20 minutes to get him in physical restraints. Prior to him being in restraints... I'm not sure how anyone would have expected him to sit still while you shot him up with ativan or something. 

 

 

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1,200 Posts; 8,058 Profile Views

Is it me or do you feel like this then becomes a chemical restraint thing instead of using physical restraints?  The facility then claims its restraint free.

I’ve tried reading studies on this today.  What I’m reading is you end up using pain and sedation in higher doses, which is completely contraindicated in Neuro icu patients.  
 

I truly only try to restrain my vented patients, but especially in Neuro, patients harm themselves quite frequently and it’s not their fault, but they need reminders as I like to call them.

One study stated they used Mitts first, but mitts are a restraint so I didn’t get how they thought they were decreasing the use of restraints with mitts.  This was a nurse driven study as well.

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764 Posts; 9,277 Profile Views

Be sure you have malpractice insurance, the hospital won’t have your back when the falls start increasing and self extubations will automatically become your fault for not being there.

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Daisy4RN has 20 years experience and specializes in Travel, Home Health, Med-Surg.

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I do not see how this could possibly be safe for pts or staff. I have never worked in a restraint free facility so dont have any practical solutions. I would want to know the rationale, see the official P/P, and know what to do when it hits the fan. And agree with others to have malpractice insurance on board because admin will most definitely throw you under the bus. Also just curious, is the sitter a nurse, if not are you/the nurse still responsible for these pts in the sitter room?

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CritterLover has 21 years experience as a BSN, RN and specializes in ER, ICU, Infusion, peds, informatics.

926 Posts; 11,731 Profile Views

I've seen LTC facilities that are restraint free, but not an acute care hospital. Usually in LTC the "restraint free" includes chemical restraints, not just physical ones. And let's face it: in ICU, sedation might be restraining the patient in a way, but is largely for the patient's comfort/safety.

I'd be very interested in how this works. Cleveland Clinic is a well respected entity so I suspect they've figured something out.  I'm wondering, though, are they truly 100% restraint free? If they are truly restraint-free, they aren't publicizing it. It does look like they have done some studies to decrease restraint use, but nothing says they are eliminating it. An older study had their goal at <4% for non-ICU patients and <25% for ICU patients.

I realize that you work there and you definitely are more aware of what is going on than google, but is it possible this is more rumor than fact?

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