Published May 15, 2003
My mom's brother just had bypass surgery on Monday and has apparently been dealing with ICU psychosis. He is normally somewhat claustrophobic and with everything else going on in ICU, he is having difficulties. The nursing staff had to resort to applying restraints as he was trying to take out his iv and other various tubes. A friend of my uncle's wife is now trying to tell my mom that this is illegal. I don't see how that is possible when they are just trying to prevent him from hurting himself. She asked if I had ever heard of anything like that and I told her that I would look into it. Any thoughts or experiences would be appreciated. Thanks.
JCAHO doesn't like restraints to be used but when a pt is pulling out lines that could cause him to bleed to death then I believe restraints are justified. Document, document, document. But NO restraints are NOT illegal. If a pt is a danger to himself or others then restraints are warranted. I also like to have wrist restraints on any pt that is intubated. Sorry but you never know when they are gonna go "loco" on you. Better to be safe than sorry.
I agree... you have to balance out the positives and negatives. While restraints aren't the ideal, the risk of having a patient extubate himself or pull out an arterial line -- not to mention the risks of having to put them back in emergently -- is far worse. I have some more information at my website, feel free to look it over and print it off...
Thank you very much for your responses. Just to let you know she wasn't trying to get the nurse in trouble. She thinks they have been great. She wanted to be able to prove the wife's friend wrong.
One question. Was a family member willing to stay at the bedside 24/7 in lieu of the restraints?
My mom was the only one willing to stay any length of time and she couldn't do it 24/7. She is 63 years old and has back problems. My uncle's wife and kids were too worried about shopping and finishing vacations. He is doing much better now though. He is home from the hospital and is much more clear-headed. He is still weak but is recovering.
And I don't think the responsibility should rest w/ the family 24/7. They have enough to deal with, and often have their hands full when the patients get d/c'd too. Not to mention the liability issues for the hospital as well...it's almost like we're asking the families to do what the hospitals should be doing in the first place...keep their loved ones safe!
renerian, BSN, RN
I agree with all the posts except the last one.
Originally posted by renerian I agree with all the posts except the last one. renerian
I'm curious to hear your thoughts...I'm not saying the family should not participate and take responsibility, just that they shouldn't have to assume 24/7 responsibility for sitting w/ the patient. Those who require prolonged periods of supervision realistically would be restrained at times, attended by family when they are able, and supervised by hospital staff when the family is unavailable and/or restraints are aggravating their agitation.
Of course w/ my experience being limited to the acute care setting, I can only express my opinion for that situation.
Although I work as a psych nurse I know the hospital I work in has a policy for medical use of restraints.Also,having the family as a "partner in care" is becoming much more accepted and I think it's a good thing especially for the patient.
in my unit, we have standing protocol, that says if they try to pull lines/tubes out, then soft restaints are ok. we have q 24 hour orders & flow sheets to follow. some times you gotta use them.
When my grandmother and father were pulling all their tubes out our family took turns watching him to support the staff. I know it is impossible for a nurse to be everywhere watching all the clients who are pulling out tubes. It did not bother us at all. They said they appreciated it as well.
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