Things that make ya go, Hmmmmmmmmmm

[mindlor]

So I am on a hospice unit, my preceptor boasts that they are a zero restraint unit.

We go into a pt room and the pt is restless and half way out of bed and very disoriented.

We help him back in to bed.

Preceptor says, "Hey take those pads that are on the floor and stand them up on each side of the bed, then unlock those two high back recliners and use them to push the pads against the bed and be sure to lock the brakes on each chair."

I did as told and thought to myself....

Hmmmmmmmmmmm

[NurseOnAMotorcycle, ASN, RN]

[nightengalegoddess]

legalese.....we restrain people all the time......even sleep meds are kinda like restraint if ya think about it. Sounds like she was just using common sense. Like if we were doing this at home, 80 years ago. It IS less dehumanizing than actual wrist and ankle restraints, must admit.........

[mindlor]

True, and you are spot on about sleep meds, ativan, etc being restraints. I agree with you one hundred percent. However, if they fancy themselves a zero restraint unit they shouuld not be using any of thngs for the purpose of controlling a patient. Yes? No?

[4pancakes]

mindlor,

HMMMMM is an understatement!!!!!! WHY NOT JUST SAY NO? I AIN'T DOING IT!!!!!!!!!!!!! You have the right to refuse to do something you no is wrong, or that you no could hurt the patient, or yourself!!!! NO ORDER, NO DEAL!!!!!!!!!! And, what MD, would order something like that? None I presume!And, even if he did, then, say, I am not comfortable with that order, can we try this instead?... By law, you must report any elderly abuse you witness. Be careful! Just my :twocents:.

[chevyv, BSN, RN]

That was 100% a form of restraint! Unsafe as heck too. I agree with being careful, it's your license. I work in a psych hospital and they want to be restraint free, but that is not gonna happen. It's county psych too.

I don't understand all of the hoopla. I don't go to work hoping to put someone in 4pnts and when I have to, it's for the shortest amount of time possible.

If a loved one is trying to climb out of bed and safety is an issue, I would want someone to do something before injury occurs. The use of siderails or putting chairs by the bed to prevent someone from getting out is a form of restraint for sure.

[FLArn]

This patient might possibly have been terminally agitated if you are on a hospice unit. The proper course would have been to obtain an order from the MD for medication (probably Haldol or Thorazine depending on the MDs preference) and maintain a peaceful environment (quiet, low light, minimal stimulation). 1:1 sitter if available (our hospice has volunteers who are trained for this task). Don't be afraid to use your volunteers if they are available as per the conditions of participation for hospice a certain percentage of services are to be provided by volunteers.

[mindlor]

Yes yes, haldol was ordered and given. They were also on a huge amount of morphine. And indeed, the term, terminal restlessness was mentioned....

Now for more details....the patient was moaning in agony and holding his abdomen. I should also state that this patient is considered palliative and is still receiving treatments that prolong life.

That said, i observed the nurse....one, they never addressed the patient directly, the nurse would talk to me about the patient. I addressed the patient and they were responsive and able to verbalize their pain level etc...

Not once did the nurse assess bowel sounds...I did and they were off the charts hyperactive in all 4 quads...

I asked the nurse when the lat BM was and they said EIGHT days ago. PT is passing gas so no ileus. Not no ileus does not mean no impaction. I mean for god sake right?

The nurse says we dont want to do anything to help them have a BM because we are waiting for radiology to read their films...

Any of you guys ever had really bad gas cramps? It sucks. I should also mention that I am a student and not yet licensed.

[Esme12, ASN, BSN, RN]

true, and you are spot on about sleep meds, ativan, etc being restraints. i agree with you one hundred percent. however, if they fancy themselves a zero restraint unit they shouuld not be using any of thngs for the purpose of controlling a patient. yes? no?

restraint is considered anything that prevent the patient from following the path they desire. no, they are not a restraint free facility and yes what they are doing is a form of restraint. they have themselves deluded that they have beat the system...if dph, cms, or jc comes a knocking........ heads will be a rolling!

http://www.thenationalcouncil.org/cs/public_policy/restraints_seclusion_rules_chart

provisions interim final rule for hospitalsifinal rule for hospitalseffective dateaugust 1999january 8, 2007

definition of restraint

any manual method or physical or mechanical device, material or equipment attached or adjacent to the patient's body that he or she cannot easily remove that restricts freedom of movement or normal access to one's body.any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely.

a restraint does not include devices, such as orthopedically prescribed devices, surgical dressings or bandages, protective helmets, or other methods that involve the physical holding of a patient for the purpose of conducting routine physical examinations or tests, or to protect the patient from falling out of bed, or to permit the patient to participate in activities without the risk of physical harm (this does not include a physical escort).

chemical restraints or inappropriate use of medicationa medication used to control behavior or to restrict the patient's freedom of movement and is not a standard treatment for the patient's medical or psychological condition.a medication used to control behavior or to restrict the patient's freedom of movement and is not a standard treatment for the patient's medical or psychological condition.definition of seclusionthe involuntary confinement of a person in a room or an area where the person is physically prevented from leaving.the involuntary confinement of a patient alone in a room or area from which the patient is physically prevented from leaving.

staff must have education, training, and demonstrated knowledge based on specific needs of patient population. minimum of

1) techniques to identify staff and patient behaviors, events, and environmental factors that may trigger need to use restraint or seclusion,

2) use of nonphysical intervention skills,

3) choosing least restrictive intervention based on individualized assessment,

4) safe application of restraint and seclusion, including recognition of and response to signs of physical and psychological distress,

5) clinical identifications that restraint or seclusion is no longer necessary,

6) monitoring physical and psychological well-being of patient (e.g., respiratory and circulatory status, skin integrity, vital signs), and

7) first aid and current cpr certification.

http://www.jointcommission.org/mobile/standards_information/jcfaqdetails.aspx?standardsfaqid=260&standardsfaqchapterid=78

http://www.premierinc.com/safety/topics/patient_safety/index_3.jsp

http://www.drcnh.org/restraint.pd

[nightengalegoddess]

OOohhhh....It DOES get uglier to hear that the patient WAS AWARE ENOUGH to verbalize the source of their discomfort and your preceptor had no idea how to communicate with this poor patient!!!!!!!!YUCK! And this is hospice??Ugh. Nuff said. I feel your agony. We live in such a dehumanized place sometimes. You did well.....you listened to the patient. At least, YOU will have the sense to prevent these kinds of options in the future!!! oxoxox

[nightengalegoddess]

Again, uh, what is the problem with at least trying a suppostitory to feel for impaction.....and then just "whisking" around a little bit. I think this preceptor knows very little about true nursing; more than just the rates, numbers, rythyms, lab values....etc. Palliative is comfort. If that has to do with at least attempting to unleash a turd.....and someone can't helped with a gloved hand, than what is the point? ....I am just flabbergasted..ugh

[Flare, ASN, BSN]

so that nurse should have gotten her butt on the phone immediately to radiology to make sure those films are read. 8 days of no BM would have me climbing the walls. Shame on her for just blindly corralling him in instead of looking at the big picture.