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.
I wish it was a rumor! They have already taken away the posey vest and the wrist and ankles are leaving on the 2/24.
They use heavy sedation but i have a problem with that when it comes to my neuro patients and my eldery patients take cant metabolism these drugs quickly. Some genius gave benadryl to a patient with liver disease... he was high as a kite for 4 days. NIH went from a 6 to a 20+!!
Specializes in ER, ICU, Infusion, peds, informatics.
How are their other facilities handling this? Just the heavy sedation? How long have they been doing this total? Is it a relatively new policy? Heavy sedation by itself isn't going to cut it for long -- you'll start having negative patient outcomes.
How do we keep our patients safe AND the staff safe.
Please help!
Have you asked management this? Your concern for safety is valid. Is this something only happening on the floors? If so, there must be an alternative solution that they can offer. I can’t imagine not having restraints available on my vented patients in the ICU.
I feel bad for the staff and patients and their families in this situation. Maybe I only know one way and that’s why I can’t picture a positive outcome. I would be voicing my concerns on a daily basis—in person and through emails—and asking for recommended solutions.
Truthfully, I’m curious what the response and overall outcome will be. I hope you’ll return to update us.
Last night an educator stopped by for an in-service. Not related to restraints. But I couldnt resist bringing it up!
So we were hearing through the grapevine that posey vests were being taken away. There were several dates in feburary thrown around but finally on 2/10 we no longer had posey vest in the shelf. No email. No discussion. Posey vest were just no longer on the shelf. Last week a coworker told me the restraint team came around and said wrist and ankles will be removed on 2/24.
Last night the "educator" confirmed wrist and ankles will be phased out over 5 to 6 months. But they will still remain in icu and the er. And we can still have mitts. Of course i asked if the mitts are to soften the blows when the patient hits me? Icu is typically 1:2 ratio and we are 1:6 ratio. And the ER has secuirty AND police officers... all over. So take the restraints away from the people who need them... on the floors! We all need them though!Then it was said we will have more sitters... maybe. So they can be hit and abused? I dont get it. They dont get it! And its all terrifying!!
I had a pt in leather restrains with a police office in the room who still managed to attack the officer who was screaming for help. 4 points and a posey, a patient who said he ate children and enjoyed the taste was trying to drink from his peg tube. And he would have been successful if it wasnt clamped!
Also i just want to clarify that I started to refer to our floor as ICU holding because we just switch patients back n forth between us and icu. Most of out patients are hospice or too sick and want to live but the doctors have no idea what to do anymore. We are a pcu floor without the hardwired resources or the staffing ratios.
I would really like to hear from people that work in restraint free hospitals. How do we handle this??? We have a few nurses that came from restraint free hospitals and they said many people just used sheets to tie people down. Really?? Is this something that happens. If so, its part of the problem!!
Our complains have fallen on deaf ears. They could care less this is how we feel.
I wish it was a rumor! They have already taken away the posey vest and the wrist and ankles are leaving on the 2/24.
They use heavy sedation but I have a problem with that when it comes to my neuro patients and my eldery patients take cant metabolism these drugs quickly. Some genius gave benadryl to a patient with liver disease... he was high as a kite for 4 days. NIH went from a 6 to a 20+!!
We've been doing this for some time. For our vented patients, we use pain control and some sort of sedative. We've switched to using Precedex more often. It can cause bradycardia and hypotension, takes awhile to titrate for effect but doesn't suppress respiratory depression so its great for weaning. Pt's can be on a low dose, awake alert but comfortable, not pulling at anything. I love it. We also use Freedom splints. They wrap around the elbow to prevent bending of the arm. It's supposed to prevent them from reaching for tubes, lines, drains, etc. Not fool proof but allows you to have more time to respond if they do reach something. I've noticed a few things....patients actually are more comfortable (for the most part) than when in restraints. They become less confused. 4 side rails are not considered a restraint when pt is sedated or on beds that actually turn the patient (safety issue). I employ family members and friends to keep the patients company and be their "sitter," unofficially of course. I am still closely monitoring but it gives me some breathing room to take care of my other patient. This usually works well in my experience bc it gives the family a job. They feel useful, don't bother you as much, and usually end up becoming exhausted, going home to sleep and thanking you for a job they just realized is harder than it looks. LOL. We also developed an ICU delirium policy that proactively assesses for delirium amd medicates..usually seroquel or some other antipsychotic. We stay away from benzos and benadryl bc it makes delirium worse. And after awhile you'll love it bc you won't have to do the restraint charting. Before this went into effect, I used to come on shift and remove restraints for certain appropriate patients just to avoid restraint charting. And as for sitters, we tried to get rid of sitters bc the money spent was ridiculous. But, they have realized that you do need them in certain cases. And there is a big difference in medical restraints vs behavioral restraints. Also, something we'll do in the ICU if we do have sitters, is actually chart in the room at the bedside on the WOW! to allow the actual sitter to help out the other nurses with their care and toileting of other patients for a certain amount of time. Or also if I'm gonna be in the room awhile giving meds or doing care, have ghe sitter round on other patients. You just learn to get creative. As with any change, theresna transition phase. Sorry for the long post but hope these ideas help.
Verygreennurse
16 Posts
I wish it was a rumor! They have already taken away the posey vest and the wrist and ankles are leaving on the 2/24.
They use heavy sedation but i have a problem with that when it comes to my neuro patients and my eldery patients take cant metabolism these drugs quickly. Some genius gave benadryl to a patient with liver disease... he was high as a kite for 4 days. NIH went from a 6 to a 20+!!