Restraints

[emm1256]

I have a question about something that I observed on the floor the other day. If a restraint order is set to expire at 0730 and the doctor does not renew until 0900, what do you do for those 1.5 hours that you do not have an order? Do you leave the patient in restraints? Or do you remove them?

Regarding the specific patient that I observed, the restraints remained in place and none of the other nurses on the floor seemed to have a problem with this. Maybe its because I am new that I am thinking this is wrong?

Any input would be greatly appreciated.

[Triddin]

This is the main study that articles misinterpreting the restraint/extubation/delirium cites:Influence of Physical Restraint on Unplanned Extubation of Adult Intensive Care Patients: A Case-Control Study

This is a chart review based study, meaning it did not compare evenly matched patients where one group was restrained and the other was not, to determine if there is a higher risk of unplanned extubation when a patient is restrained.

Instead, it found what you would expect; that patients deemed at higher risk for self extubation and therefore were restrained were more likely to self extubate, and that patients deemed a low risk and therefore not restrained, such as those with low GCS scores even without sedation, were less likely to self extubate. Delirium is associated with restraints and self extubation in that intubated patients with delirium are more likely to be restrained.

That makes a lot more sense with what I've experienced in practice. I was trying to imagine some of our super delirious patients without restraints and how we would prevent self extubation considering some manage to do it while still restrained lol. Thank you