Use of Restraints on Intubated patients - ER and ICU

[MassED]

Ok, so I'm definitely unsure of the state/federal laws on using restraints for intubated patients that are used solely to prevent a patient from pulling out their ET tube. I regularly place soft wrist restraints on my intubated patients. Often we have to adjust their sedation and I once had a patient pull out her tube, so I'm very cautious.

There's an educator where I work whose specialty is geriatric psych, so I'm not sure she knows how the law/rules apply for our specific population/environment, since this type of restraint is different. She states we need an order.

I haven't been able to find the specific laws on this topic. I have been looking for resources to be able to check my own nursing practice. I'm sure I'll be called out again for this by this educator, so I just want to be sure that what I'm doing is not just "how we've done it," or is there validity to what I have been doing.

I also do not regularly see orders for an ICU patient that has "soft wrist restraints" as an order to protect ET tube.

Ideas? Thoughts? Resources?

Thanks!

[elkpark]

Yes - DNI. Can use non-invasive ventilation but nothing more. If my wishes / AD was ignored in a hospital, the people responsible would be in court for battery and false imprisonment as well as up in front of the Medical council so I would suggest they get trained in an alternative career. What so called medical professionals keep forgetting is that they are not god. If a person is "competent" or has an AD they cannot by law go against this regardless. The more people realised this and kept control of what is done to them the better it would be.

You would have to be alive and physically able to take someone to court in order to make good on your threat ... Hospitals ignore ADs all the time; I've personally seen it happen many times (I'm not saying I agree with that or that it's a good thing -- just that the reality is that it happens all the time).

I've seen individuals who were awake and alert, conversing reasonably in the bed, who I was seeing because I was a member of the psych C&L service that was consulted specifically to render an opinion about whether the individual had capacity to make the decision to refuse life-sustaining treatment, and my service said, yes, the individuals had the mental capacity to make that choice and their wishes should be respected, and the hospital went ahead and continued treating them anyway, while they lay there in the bed and said, stop, no, don't do that, I don't want that, to the individual nurses and physicians.

As for having "DNI" or "DNR" tattooed across one's chest (which I've heard of many times), I used to joke about that myself until the topic came up casually in conversation with a healthcare attorney who told me that that would not be legally binding or taken seriously by anyone (still fun to joke about, though ... :))

IMO, the trick is to avoid going to the hospital in the first place.

And that's the last of my going off-topic on the thread.

[XmasShopperRN, ASN, RN]

To prevent the accidental intubation, I suggest getting DNI tattooed across your upper chest. Solve the potential issue right quick.

Hehe :)

[tnbutterfly - Mary, BSN]

ADMIN REQUEST

Several posts have been deleted as they were not contributing to the topic of the thread, but were instead merely serving to derail the discussion. While it is always alright to express your opinion, we request that remarks be constructive and polite. You are free to disagree, but please do so respectfully.

As already directed above, please keep the discussion directed to the topic of this thread which is is about the US regulations/requirements/laws regarding the use of restraints in the hospitals settings and the documentation necessary for healthcare workers.

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