Restraint without order

[Nursebirdy]

I had a combative patient who was fighting off 3+ staff with enormous strength. She was a schizophrenic who had not been taking her meds. I paged the Dr to see if he would order restraints. He never called back. Eventually we had 5 people, three nurses and two aides in the room attempting to get her back to bed. We put restraints on and I called the Dr again, at home, to update the status. He ordered a med to calm her down, but didn't confirm the restraints order. I got the order scanned, administered the med, meanwhile the patient was getting out of the restraints and trying to pull at her tubes and scratch at staff. I called the Dr back again and asked him pointedly about the restraints. He ordered a higher dose of the med and was angry that restraints were used. No order. I administered the med dose he ordered and removed the restraints.

The patient calmed down and was subdued once the med was in her system. Now I'm terrified I'm going to lose my job, maybe even license over this. I have no doubt that the situation was extremely unsafe. Every person in that room was in danger, including the patient to herself. I tried to call for more staff to help subdue her, but we no one else was available in that hall. In the end all I can keep thinking is "I restrained a patient without orders".

Feeling like my career is over...

[sapphire18]

If placing a pt in "behavioral" restraints (as in this case), usually a dr must assess the pt face to face within 1 hour. If you took off the restraints when the dr refused to order them, you should be fine...that's one of those situations where you act first- maintain the safety of the pt and everyone else- and then get the orders the dr wants carried out. I've never had a dr refuse to order restraints before, but the good thing with the face-to-face assessment thing is that the dr will see with his or her own eyes how dangerous the situation is.

ETA: this is just how things have occurred in my experience. Other places may be different, policy-wise.

[martymoose, BSN, RN]

First off, the MD is a jerk. Was he there risking his safety with that psychotic pt ? NO.

I guess I wouldn't worry. No harm was done, and if it took 5 people to keep the pt and staff "safe", who can argue that restraints were a bad idea?

Did the MD( jerk) say he was writing you up? He can be angry all he wants.If he's not acting on it though, I wouldn't worry.

Ugh, seriously, what's his deal??why not no restraints, at least til pt is controlled.

Sorry you had to deal with this..

[Nursebirdy]

The Dr is known to be difficult. Everyone at our facility rolls their eyes when they hear his name. It was 11pm and I was calling him at home. I also called the House Officer to come evaluate her face to face, which he did. But it was a resident and he said residents cannot write orders for restraints. The restraints were on for less than an hour. The attending DR didn't say anything about writing me up, but I filed an incident report and emailed my manager to let her know what happened. Now just waiting to see what happens.

[sapphire18]

That's weird that a resident can't write an order for restraints.

[Christy1019, ASN, RN]

That's weird that a resident can't write an order for restraints.

That's what I was just thinking, especially considering that he was acting as house officer!

[Been there,done that, ASN, RN]

The Dr is known to be difficult. Everyone at our facility rolls their eyes when they hear his name. It was 11pm and I was calling him at home. I also called the House Officer to come evaluate her face to face, which he did. But it was a resident and he said residents cannot write orders for restraints. The restraints were on for less than an hour. The attending DR didn't say anything about writing me up, but I filed an incident report and emailed my manager to let her know what happened. Now just waiting to see what happens.

Why on God's green earth would you write yourself up?

Review your facilities policy , does it not say you have one hour to obtain the doctor's order and have the patient seen?

You could have mentioned the difficulty with Dr. Jerk and the resident "unable" to write a restraint order.

[Here.I.Stand, BSN, RN]

I also called the House Officer to come evaluate her face to face, which he did. But it was a resident and he said residents cannot write orders for restraints.

They order them all the time where I work. Strange.

[Nursebirdy]

I was shocked when he said that too. If you can't tell by now, I'm a new nurse, less than 6 months on the floor. I filed the report about it because the nursing supervisor told me to. She said her previous facility would give an hour to get orders, but I haven't been able to look up our policy from home. My coworkers who were helping me said they agreed with the need, but my boss sees things in black and white. I guess I can only wait and see what they do. Thanks for all the feedback, I appreciate it.

[nurse2033, MSN, RN]

I don't see a problem. You acted immediately for the safety of the patient and staff. Restraints need to be removed as soon as possible, and that is what you did. I assume you documented the patient's behavior and your requests for an order. This should be dealt with through your manager (who hopefully has a spine). A physician who disregards staff safety and won't back up a nurses judgement is an a**.

[Here.I.Stand, BSN, RN]

Hugs!! If a pt is being combative (esp. if A&O), we too restrain first. Actually we have a behavioral "code" where I work, ran by psych staff and security, and if the pt is violent the team places them in 4-point leathers...I want to say they sedate also. Staff safety is ABSOLUTELY a priority. You do not have to be a martyr for your job. Plus a violent pt is probably disrupting his medical treatment, no?

[OneDuckyRN]

Maybe this is way off the mark, but here's a thought:

If you weren't already in a behavioral health/psych setting, did you have an app & cert on hand for her? I only ask because I had a patient like this once, only we had an app & cert already, and I nearly had to have security apply 4-point restraints. I would have had to get an order and an face-to-face assessment within an hour, but I could have had them applied before the order if need be, because she was a risk to herself and others. I am thankful it never reached that point, but it was good to know I had that as a backup if I had needed it.

I guess my point is if you have an app & cert already, that may offer you some coverage if you need to. But honestly, I think you acted appropriately and in the best interest of the patient. It sounds like the physician you were dealing with is kind of a jerk. I've learned that with some doctors, if I want something specific, I ask for everything but what I actually want because they won't give me what I ask for.