do u need a physician order for a therepeutic hold?

[smartnurse1982]

Also, I noticed the mental health assistance just do it without my input. I'm confused,iv only been at this place for 2 weeks and the social worker is training me b/c I'm the first nurse on board. They were agroup home but trying to upgrade to a psych residential treament facility. Any responses appreciated. Thanx

[txredheadnurse, BSN, RN]

if this group home/facility is regulated by the State then you need to check the guidelines and regulations regarding restraints which includes "therapeutic holds". In my state there must be a behavior plan with a hierarchy of interventions and behaviors to justify restraint holds, use of a restraint/hold must be approved by a human rights committee and reviewed at least annually, there is a restraint checklist and accompanying documentation to be filled out by the staff doing the hold, the nurse must obtained a doctors order for the hold and the nurse must physically assess the resident after the hold is released. For both the order and the physical assessment our state gives a time line for the nurse to follow.

If the social worker is training you she should be aware of these guidelines. If not then I would strongly suggest you ask for input by a QA person or your medical director if you have one. In my state any restraints are reviewed during the survey process and omission of any of the steps I listed above can result in a deficiency; a consistent pattern of omission or non compliance to guidelines can result in more serious consquences during a survey.

[smartnurse1982]

Update: this same facility,after I asked them about a physicians order before initiating restraints,fired me this morning. According to m.y agency,it might have been the fact that I was persistent about knowing the proper protocol for restraints. Also, those lying residential managers made up some lies.

[txredheadnurse, BSN, RN]

I'm sorry you got fired but it sounds as if you are much better off out of there. No job is worth losing your license over or living with the fact you know things are not being done legally or in the best interest of the resident.

[1TachyRN, RN]

I don't know the mental health assistants' reasoning for initiating a hold, but you're not supposed to unless the patient is a danger to themselves or others- punching walls, throwing chairs at others, etc. You can't do it just because a patient is yelling, cursing, or refusing to follow staff direction. And you do need a physician's order for a therapeutic hold and the patient's guardian has to be notified as well. At my former facility, there was also extensive paperwork involved because we had to justify putting the patient in a hold. But we were dealing with children and adolescents, so I don't know if it would be different for adults, but I can't imagine that it would be too much different.

It sounds like this place is going to have to learn the hard way the proper and legal way of doing things, and that you're better off without them.

[rn4ever?]

In our facility, yes.

[blondy2061h, MSN, RN]

Lol, I read "therapeutic hold" and was thinking about like holding a baby in a knee-chest position during a tet spell.