Restraints - Face Up Or Face Down?

z's playa · Apr 11, 2004

I work in a small Psych hospital, and the majority of pateints are Adolescents. Hospitals policy for 4 point restraints has been to restrain the patient face down (we use leather restraints on each limb).
Recently the State agency in charge has strongly recommended face up (due to a recent death in another hospital), so we have been trying face up when able, but continuing to use face down as well.
My question is what are other peoples experiences with this, and which do you prefer? Which is safer?
Having been trained initialy in Face Down - I tend to prefer this and find I get spit on less, and have easier access to give injection. Also feel Pt. is less likely to choke.
Thanks.

Face down? I would be worried about suffocation and being sued soon after myself! One step away from being hog tied if you ask me. My fiancee restrains psych. all the time in the ED and on the face is not done. Maybe initially to get them down but they get flipped over as soon as possible...sometimes spitting which is what the masks and eyewear are for. my 0.02.

Trauma Columnist · Apr 11, 2004

NEver, ever face down! How can you adequately assess them! I work level one trauma center and we restrain frequently. Would be very afraid of suffocation and death!

sbic56, BSN, RN · Apr 11, 2004

Face down?? Never heard of that being an acceptable way to restrain for all the afore mentioned reasons!

jnette, ASN, EMT-I · Apr 11, 2004

Face down?? Never heard of that being an acceptable way to restrain for all the afore mentioned reasons!

Wow.... I've never heard of that, either !!! As mentioned above, how could one do any kind of assessment that way? Seems like it would be too easy to miss something going on that way, not to mention added indignity.

Don't like the face down idea at ALL. :stone

walterrn · Apr 11, 2004

JCHAO standards states "Face up". Many adolescents have sexual abuse issues. Also, easier to assess ABCs. A little spit? I hate spitters, but I've had projectile bloody vomit spewed on me by an end stage AIDS client. A little spit (although disgusting) never hurt anyone.

Walter the Nurse

I work in a small Psych hospital, and the majority of pateints are Adolescents. Hospitals policy for 4 point restraints has been to restrain the patient face down (we use leather restraints on each limb).
Recently the State agency in charge has strongly recommended face up (due to a recent death in another hospital), so we have been trying face up when able, but continuing to use face down as well.
My question is what are other peoples experiences with this, and which do you prefer? Which is safer?
Having been trained initialy in Face Down - I tend to prefer this and find I get spit on less, and have easier access to give injection. Also feel Pt. is less likely to choke.
Thanks.

z's playa · Apr 11, 2004

JCHAO standards states "Face up". Many adolescents have sexual abuse issues. Also, easier to assess ABCs. A little spit? I hate spitters, but I've had projectile bloody vomit spewed on me by an end stage AIDS client. A little spit (although disgusting) never hurt anyone.
Walter the Nurse

As I mentioned before, my fiancee restrains psych in the ER all the time and has needed to get tested once a month for 6 months on two seperate occasions after a pt spat in his eye. The eye apparently absorbs quickly and it is possible to contract diseases this way. Hence the Hep C and HIV testing.

I've personally never heard of anyone contracting this way but I never say never.

psychomachia · Apr 11, 2004

I work in a small Psych hospital, and the majority of pateints are Adolescents. Hospitals policy for 4 point restraints has been to restrain the patient face down (we use leather restraints on each limb).
Recently the State agency in charge has strongly recommended face up (due to a recent death in another hospital), so we have been trying face up when able, but continuing to use face down as well.
My question is what are other peoples experiences with this, and which do you prefer? Which is safer?
Having been trained initialy in Face Down - I tend to prefer this and find I get spit on less, and have easier access to give injection. Also feel Pt. is less likely to choke.
Thanks.

I would do a little research on positional asphyxia. It's become a big issue with EMS / law enforcement providers - http://www.charlydmiller.com/ranewz.html

http://www.educationoptions.org/programs/articles/SuddenDeath.htm

http://www.fbi.gov/publications/leb/1996/may966.txt

http://www.amnestyusa.org/rightsforall/police/brutality/brutality-5.html

lovinghands · Apr 13, 2004

Wow! I was surprised by this post. I have worked in a rural state psychiatric hospital for the last 10 years and positional asphyxiation has been a hot topic for the last 4-5 years.

When I first started working at the hospital, we had the option of laying pts face down when in 4 or 5 pt restraints, though we never did even if they were spitting or biting because of the fear of suffocation. In the last few years we have moved almost completely away from restraint use. Not easy to do but if a pt does need restraint we have a special restraint bed with wheels - its like a flat recliner (quite comfortable).

The biggest concern our administration had about laying pts face down was when staff were attempting to get a pt under control. We generally took them into seclusion and laid them face down to give them an IM and staff were able to back out of seclusion easier. This is totally unacceptable now by our facility becaue of nationwide documented deaths, particulary adolescents. We are now trained to use special upright holds to manage pts and if an IM is necessary, they are placed in a sidelying position. It took a lot of staff education and encouragement to make this change happen in our large facility.

I hope this information helps. I really encourage you to do some more research on this topic as it is a major liability issue in psych care.

PRNMEDS · Apr 13, 2004

Thanks for all the info. I plan to research it some more. I was suprised by the overwhelming feeling that face down is so bad. I had never considered it as more likely for suffocating since we have 1-1 staff with patient head near staff, can't choke on vomit. In any event since response was so one sided I will certainly read the info graciously provided here.

I have only recently discovered this site and think this forum is a wonderful learning tool and would like to encourage others to utilize this. Thank you.

care bear · Apr 20, 2004

I currently work in a mental health facility and our policy on physically restraining patients/clients has changed due to the increaing issue of positional asphyxia. We restrain the patients physically ourselves and not with ankle or wrist restraints.

We were initially trained to position & physically restrain the patient face down for ease of administration an IM injection, so the patient cannot bite or spit on the nursing staff and ease of moving the patient into the seclusion room. However we are now taught to physcially restrain with the patient face up. Very difficult to administer Im meds or prevent the patient from spitting or biting the staff. It also makes it easy for the patient to hit or kick the nursing staff if the get loose.

Personally, I prefer to restrain the patient face down. If the staff are trained properly, positional asphyxiation shouldnt be a problem.

susanmary · Apr 20, 2004

I work in a small Psych hospital, and the majority of pateints are Adolescents. Hospitals policy for 4 point restraints has been to restrain the patient face down (we use leather restraints on each limb).
Recently the State agency in charge has strongly recommended face up (due to a recent death in another hospital), so we have been trying face up when able, but continuing to use face down as well.
My question is what are other peoples experiences with this, and which do you prefer? Which is safer?
Having been trained initialy in Face Down - I tend to prefer this and find I get spit on less, and have easier access to give injection. Also feel Pt. is less likely to choke.
Thanks.

Address any questions/concerns with administration. Be certain that you are validated in proper use of restraints (doesn't matter what anyone else on this board says -- great to hear other's opinions) -- but follow your facility's protocals. You stated that the State agency in charge strongly recommends restraining face up -- follow policy and procedure every time. Document perfectly every time. This is a big deal. I thought leather restraints were a thing of the past. Bottom line -- protect both your patient and yourself.

Personally, I don't think it's safe/appropriate to restrain "face down." No way.l

Great thread.