restraints and seclusion questions

[coachg]

Hello,

I am trying to find information about restraint and seclusion standards in pa.

I am specifically looking for if there are standard discontinue criteria for restaint patients. I am a strong advocate of there are only 2 reasons ever to restrain a patient (for behavior, not talking medical)

harm to self

harm to others

Thats it, end of story.

Now the question has come up about what happens when a patient in restraints falls asleep while restrained. It is my opinion that once a patient has fallen asleep you must start to discontinue restraints. Not all at once, if there are in 4 points then you might do one limb, then a 2nd in 10 minutes Then if they are still sleeping and or calm you take the last two off.

I really believe that is the standard in NJ but I am unable to google and find something specific for the state of Pa.

any thoughts anyone?

does anyone have any helpful links that could lead me in the right direction?

I will be emailing http://www.mentalhealthamerica.net/go/home to see about some answers

thanks

frank

[Meriwhen, ASN, BSN, MSN, RN]

In the facilities I have worked in (on both sides of the country), if a patient has truly fallen asleep there is no further need for them to be restrained, and it is immediately discontinued. Otherwise restraints are discontinued if the patient agrees to comply with the requirements for removal (e.g., no further harm to self or others), or if the order has expired and a new order has not been obtained.

I have never heard of removing restraints a limb at a time.

You should pose the question to the American Psychiatric Nurses Association:

http://www.apna.org

[Whispera, MSN, RN]

to Meriwhen: where I've worked, we always remove one limb at a time...just in case the person isn't totally ready to be calm...once we started, we removed all pretty quickly, but we didn't remove all at once.

[marshmallowstar, BSN, RN]

Pennsylvania Code

This is a link to the code relating to restraints. No mention of removal procedure other than as soon as possible. Also limbs are to be exercised and toileting offered q2 hours.

Both PA facilities I've worked at have their own policy/procedure for release and it was clear on the paperwork that accompanied such events. Both places allowed for the partial removal of restraints (limb by limb) to "test" the patient's safety. This allowed for reapplying the restraints without getting a new order. We also did vitals q15 minutes after application and then q1 hour. My practice is to do a set of vitals when they appear to be sleeping this helps me assess if they're actually sleeping, if they're still escalated, make sure they're medically stable etc. I base my decision on that assessment not just them sleeping.

You could try reaching out to one of the nurse educators at one of the teaching hospitals (WPIC?) and see if they could share their policy/procedure.

[jessmt]

The facility I work at changed the policy stating that we can not longer release one limb at a time for patient safety. They say the patient is either in restraints or out of restraints there is no in between. I guess a patient could hurt themselves with that one or two dangling restraint, or get themselves into a dangerous position if one or two limbs were released and they tried to fight the restraints. We did not find evidence supporting the release of one limb at a time.

We do release the restraint if the patient falls asleep.

[Meriwhen, ASN, BSN, MSN, RN]

to Meriwhen: where I've worked, we always remove one limb at a time...just in case the person isn't totally ready to be calm...once we started, we removed all pretty quickly, but we didn't remove all at once.

We've done that, removed them one at a time and once we started got them off of the patient. I meant that in the facilities we've worked in, we didn't do the OP's "remove a restraint every 10 minutes."

[rotary]

It depends on the reason for restraints in the first place and what the circumstances are when they fall alseep. If they're suicidal and sleeping I'll remove and place them on close observation. If they were physically threatening others I'll loosen them but leave them on if they're sedated/sleeping during the day. At night when all the patients are in their rooms I'm more inclined to release them.