restraints and JCAHO

[sweetieann]

On a psych unit, medical restraints require q 2 hour documentation and behavioral q 15. Our flowsheet states that ROM should be done every 15 minutes. Many times, this is not feasible--obviously if the pt required restraints, they are likely combative. Also--what if pt is sleeping? How do your you/your hospitals handle this?

[FowLaf24/7]

This is an excellent question. It may be a question which one should ask for advice from JCAHO. The use of restraints in a psych. unit would be dealing with a patient with very unique set of symptoms and cause. In the medical unit it usually is a patient who is experiencing delirium, a temporary medical situation which can be taken care of in a very short period of time, once the medical cause is found. In the psych. unit the patient is experiencing a psychiatric condition, which is relying on the medication to take affect, which could take several weeks even with the right medication(s) and dosage(s). Very good question indeed...

[Larry77, RN]

Our flow sheets and policy is ROM every two hours

[classicdame, MSN, EdD]

Your Quality officer (or person) should be able to answer this. If you are that person I recommend contacting JC directly. They are generally easy to talk to and communication does not mean an automatic survey.

[Whispera, MSN, RN]

Our policy required ROM Q2H as well. If it was impossible, that was documented in the nursing note, as to what was attempted, when, and why it could not be completed, and the flow sheet said "see nursing note." Also, ROM was only attempted one limb at a time, with the other three remaining restrained. If it wasn't possible even then, the documentation thing kicked in.

[elkpark]

I've never seen a policy that required ROM q 15" -- q 2 hrs is what I'm used to, also. Now, I've seen lots of flowsheets set up in a chart format for q 15" documentation of the constant observation, and the food/fluids, toileting, ROM, etc. columns had boxes for every 15", because of the graph/chart format -- but you weren't expected to do all those things every 15", just when they were due.

Shoot, those of us who aren't restrained often go more than 15" without moving a particular extremity -- that seems like serious "overkill" for someone who's in restraints.

I would ask up the chain of command at your facility for clarification of the policy.

[dragonflydani]

i would like to think a person rearing up out of bed in a combative fit would fill the ROM qualifications.

So just un-strap em, stand back, tackle them again and call it good?

*kidding ofcourse*

good luck!