staff safety

[kenyanthropus]

I could use a little help, I work in an adolescent psych unit. In the past year or two we have seen an increase in assaults on staff, this is due to several factors, one of which is the dept. of mental health's mandate to cut down on the number of restraints, this also includes chemical restraints (prn im's). We all know that the least restrictive measures mut be employed to get a patient under control, but at times, assaults on staff are unprovoked and injuries occur.

On the 11-7 shift, there are generally only two staff on duty, when we have to take an out of control patient down, one of us has to leave the other holding the patient while the other goes to the office to call for help on the phone, here is my question, does anyone know of a wireless security alert system, such as a pen or watch, that can be worn by the staff to alert other staff to respond to our call for assistance?

[lucianne]

I don't know of any specific alert systems, but I'm sure there must be some similar to the fall alert alarms used with older people who live alone.

If your facility wants to cut down on the number of restraints, it seems to me that they are approaching the problem the wrong way. Ideally, the point is not just to reduce the numbers (i.e. # of restraints, physical management, incident reports, etc.) but to help the patients maintain self-control and use de-escalation effectively. What kind of de-escalation training do you receive? It may be necessary to use a different or an additional training method if you are having a lot of assaults. Is there something about the way your unit is set up that can be changed to allow privacy and safety while a patient regains self-control? What seems to be the most common precipitating factor? Can unit policy be changed to address it? Does some of your staff have a punitive, authoritarian attitude (and I realize that third shift usually inherits the conflict that has gone on during the earlier shifts)? Is it possible to add a third staff person at night or to have security do frequent walk-thrus?

I hope this situation changes on your unit soon. It sounds like a disaster waiting to happen.

[CharlieRN]

Our facility went through a similar push for reduced restraints. It can be done. However, the trick is to have the alternative plan of practice clearly taught to the staff and in place before you start the reduction. If you do not you will find yourself with staff using a plan of care that involves the expectation that at a certain point they will restrain or force meds on the patient. When that point comes and the restraint is not available something or someone gets hurt.

Usually there is a "do it our way" expectation amoung psych staff. They expect to enforce limits. The reduced restraint approach usually involves a compleatly different plan of care. The rules have to be a lot more flexible and a real effort has to be made from the begining to find a cooperative solution to each patient's problem. The "cooperative resolution" can't be expected to happen instead of the "restraint resolutin" at the the end of the same plan of care.

[Future_Nurse_Natalie]

At Flower Hospital where I live, the nurses have wristbands with a button that summons security. I am just starting clinicals there and as much fun as a "take-down" sounds :chair: *insert sarcasm here* , I am going to push for student nurses to have wristbands as well.

[CharlieRN]

Our facility went through a similar push for reduced restraints. It can be done. However, the trick is to have the alternative plan of practice clearly taught to the staff and in place before you start the reduction. If you do not you will find yourself with staff using a plan of care that involves the expectation that at a certain point they will restrain or force meds on the patient. When that point comes and the restraint is not available something or someone gets hurt.

Usually there is a "do it our way" expectation amoung psych staff. They expect to enforce limits. The reduced restraint approach usually involves a compleatly different plan of care. The rules have to be a lot more flexible and a real effort has to be made from the begining to find a cooperative solution to each patient's problem. The "cooperative resolution" can't be expected to happen instead of the "restraint resolutin" at the the end of the same plan of care.

I wanted to add an example of how this works. We used to have a ridged bed time on our adolescent program. 10:30pm was absolute lights out. No patients were allowed out of their rms except to go directly to and from the bathroom. There was always a power struggle over this with consequences being handed out and pts priveledge levels being dropped for misbehavior at bedtime.

Tonight when I walked through the unit at 12:30am three kids were up in the community area in front of the nurses station. They were, safely, quietly, sitting playing some sort of educational video. Staff was aware of them, but not trying to force them to bed. They inturn were not disrupting the unit or keeping their peers up. A cooperative solution to the fact that not every adolescent can sleep at 11pm, had been found.

[NPAlby]

I worked in a state forensic psych hospital and we used hand held radios. If something happened on the ward, you would call it on the radio and emergency responders (2 nsg staff q shift) and security would respond. Usually more staff members, those not busy on their own wards, would respond as well. It was great I really miss that b/c everyone responded so quick within a 1/2minute most times. Now I work at another forensic psych facitlity and we have black phones along the walls. Once the phone drops security responds. But this takes a lot longer than a minute as they take the elevators and (the security guys) are not really on the wards like the other place and noone other than security knows you're in trouble. Another problem the patients love playing with these phones. We have one that when she gets upset pulls the phone off the wall. Dangerous considering how they can so easily be used as weapons. We're also restraint free, another problem there considering this is forensic psych with violent poor impulse control pts.

Hope your place does something to address and not wait till something really bad happens.

[PRNMEDS]

During the past year my hospital has also had a big push for NO RESTRAINTS. It has involved a huge change in philosophy. Charlies example of patients up struck me because we have done very similar. We also had a strict lights out, in bed policy. We still dont allow patients to use TV or common area but they may sit in room and read, play cards, games etc. This is only one example, during the day we have stopped fighting the kids on many fronts (going to room during quiet time etc.) and amazingly the restraints are dropping. Also if a patient is in restraints 2 times during a 72 hour period we have a special team meeting to come up with ideas to prevent further restraints. Its hard getting staff to buy into it, but if everyoned working together you would be suprised (I certainly am) how they can be reduced, and with less restraints - less staff injury.

[kadokin, ASN, RN]

During the past year my hospital has also had a big push for NO RESTRAINTS. It has involved a huge change in philosophy. Charlies example of patients up struck me because we have done very similar. We also had a strict lights out, in bed policy. We still dont allow patients to use TV or common area but they may sit in room and read, play cards, games etc. This is only one example, during the day we have stopped fighting the kids on many fronts (going to room during quiet time etc.) and amazingly the restraints are dropping. Also if a patient is in restraints 2 times during a 72 hour period we have a special team meeting to come up with ideas to prevent further restraints. Its hard getting staff to buy into it, but if everyoned working together you would be suprised (I certainly am) how they can be reduced, and with less restraints - less staff injury.

YES! You can reduce incidence of restraints! Get everyone on board and let them know why and how. We have seen a drasic decrease. However, it takes a lot of reminding and redireting of staff who are used to "putting grma in a gerichair" or "restraianing" someone who does not please the staff. Hold fast! You will see a drastic reduction in restraints if you set the example. i.e.-give the LOL a walk around the unit instead of an ativan. It takes time, but it's worth it.:)

[StuPer]

In our inpatient unit we have a Spider Alert system that has numerous sensors around the ward. Each staff member wears duress alarm that is activiated if the unit is dropped or if the wearer goes horizontal (hits the ground) and can also be activated by 2 buttons either side of the duress alarm, which is the size of an older mobile phone.

When an alarm sounds a computer in the nurses station indicates the precise location and number of the duress activated, everyone drops everything and heads for that location.

Obviously this is in Australia where I work, but I would be amazed if there were not similar systems available in the US.

Incidentially our unit probably only restrains about once a week on average.

regards StuPer