I work in the US, and didn't realize how out of date our views on restraints are. I've been reading a huge amount on reducing usage, and am interested in "real life" information, not just research articles.
I work in a community hospital (no trauma) in the 16 bed ICU. Out main restraint use occurs with intubated patients. We have a good amount of COPD'ers, and they end up with us due to resp failure, pneumonia, and post op slow weans.
We use wrist restraints on people usually when initially trying to reach adequate sedation levels, when waking them up for daily assessments, and when working on extubation. Our MD's can be a little conservative with weaning, and the whole process can end up taking several days. In the meantime, the patient's can get aggravated by the tube....
What do you do to keep the patient's airway safe?
I'm looking forward to answers that I can relay to my co-workers! Thanks in advance, Michele
I am a nurse on a trauma/surgery floor where we have a good deal of patients who have had some kind of head injury or are confused. Until a few months ago, we used to have a close observation room where we had a sitter watch 4 patients (we call this 1:1 still) and any patients who were on isolation would get a sitter in a private room. Well the hospital had some budget problems and they installed a video monitoring system where a tech at the nurses station will watch six patients over a video camera. Of course the reasons why I am against this are numerous: our restraint and fall rate have gone up, the four patients in the close observation room are not always the same gender - they are being watched over video but there is no tech in there, etc.
Has anybody else heard of this kind of system used?
we do have cameras on a mobile unit, that can be set up in any room, the secretary at the desk watches the monitor, but it is not always ideal as she is doing her own job as well. the other negative is that if there are no lights in the room, you cant see the patient so the patient who is acting up then has to sleep with some lights on. the floor does try to cut back on the sitter usage for monetary purposes, but on the whole, the charge nurses are quite good at insisting that we need them. they also try to minimise the restraint usage, but will use them if neccesary.
I am a nurse on a trauma/surgery floor where we have a good deal of patients who have had some kind of head injury or are confused. Until a few months ago, we used to have a close observation room where we had a sitter watch 4 patients (we call this 1:1 still) and any patients who were on isolation would get a sitter in a private room. Well the hospital had some budget problems and they installed a video monitoring system where a tech at the nurses station will watch six patients over a video camera. Of course the reasons why I am against this are numerous: our restraint and fall rate have gone up, the four patients in the close observation room are not always the same gender - they are being watched over video but there is no tech in there, etc.
Has anybody else heard of this kind of system used?
This is an example of restraints gone wrong and poor observation on the nurses part http://www.signonsandiego.com/news/metro/20080730-9999-1n30sharp.html Taken from article........... Jeffrey Christopher, 25, of Bonsall was playing cards with his mother on April 11 and became agitated when visiting hours ended at the hospital's psychiatric unit. Christopher had a history of becoming unsettled and then falling to his knees, resulting in wounds to his knees and feet. The unit's workers took Christopher to his room and had him lie down on his stomach. They secured him to his bed with restraints at the wrists, ankles and waist, keeping his head and neck above the mattress. They also gave him several medications for his schizophrenia, including ativan and thorazine. Although nurses continuously monitored Christopher, they did from a chair facing his feet instead of following the standard practice of checking a patient's face. One nurse assigned to his room said she saw him "scoot and wiggle himself lower onto the bed until his face was on the mattress," according to a report by the county's medical examiner, who conducted an autopsy on Christopher. "He then began violently hitting his face against the mattress and metal frame of the bed," and held his breath, the medical examiner's report said. During a staffing rotation, another nurse entered the room and saw that Christopher had turned blue. The Medicare report said a nurse tried to resuscitate Christopher, but did not follow American Heart Association guidelines because he had not been trained adequately. Christopher died that night. At least one-quarter of the federal report, which did not mention Christopher by name, is devoted to chronicling the series of errors that resulted in his death. "The staff did not intervene by repositioning the patient onto his back so that he would be unable to bury his face in the mattress," it said. Gross and Tarbet, the Sharp executives, said a licensed vocational nurse who was watching Christopher didn't notice that he had suffocated. "The (nurse) assumed that since the patient had been sedated, he was resting quietly," Tarbet said. ............................ I worked in a Nursing Home 22yrs ago on a youth training scheme in Scotland, and they would use bandages to restrain the residents with dementia to their chair in isolation in their room. When the authorities did checks, we had to sit with the patient and as soon as the y left we had to put the restraints back on. I was only there for 3 months, i 'm not sure if they had the whistle blowing proceedure back then and now i really which i had complained.
KneKno
106 Posts
Thanks to all of you who have answered, I appreciate you taking the time. Michele