Weighted blanket "to prevent contractures"?!?!?

Nurses Safety

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Ok, so... Apparently a hospice nurse who sees a resident at a nursing home I work at told the wife that a weighted blanket would help prevent the man from getting contractures. Mind you, he's had a CVA and is up in a wheelchair and can propel himself around, albeit he is limited with that.

At our facility, restraints are prohibited/against policy. We are a nursing home. So his wife called the state and they agreed... the blanket is a restraint. The state called and spoke with our administrator and they agreed that we needed a meeting with the family and our medical director and we were to discuss this.

The blanket, in the mean time, was removed from the room and kept at the nurse's station. Meanwhile, the wife ignored the state, and us... and had a random doctor call us to give us an order to use the blanket "prn." No can do. The hospice nurse who told the wife to get the blanket (on what basis?!?!? and show me the studies on this blanket miracle!!!!!) got an order to use the blanket. It's still against our policy! So then the wife threatened to call the police and the news station unless we gave the blanket to the resident.

People are so out out of hand these days, I swear. If they don't want to follow our regulations and policies, why don't they take them home? God love these residents... but sometimes the families make you wonder why in the heck you chose this profession. If you want to disregard our policies, leave. I'm sorry.

What say you?????

Yes, all of this came up at 4pm initially on a Friday and then every evening at 4:30 and 5pm the wife has been yelling at the nurses and aides and unit manager. There was/is a plan to have a meeting but it can't happen until Monday when everyone is back to work. :( Thank you for your reply. I just needed to bounce this off some other people. ;) I'm not sure that I felt chastised but it's been VERY stressful for the staff to have to try to take care of 25+ elderly people and then be unnecessarily screamed at by his wife after she was given this CRAZY advice... and she just wouldn't drop it. I've since been told that the nurse had a long talk with the wife and got her to calm down and she asked that the blanket be removed. Wow, huh? The light has been seen? Maybe so!

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... but It's not a restraint because it doesn't prevent movement, as you pointed out:

You or I or anyone else may believe that, but the OP has stated that the state licensing/regulating agency has already determined that it is a restraint, and that's who the facility has to answer to. The federal and state definitions of what constitutes a "restraint" in healthcare settings are v. broad. I used to work as a surveyor for my state and CMS, and I spent lots of time getting fancy explanations from facilities about why they didn't consider X, Y, or Z to be a restraint and therefore they weren't in violation of the regs, or they thought they had figured out some clever way to get around the regs about restraints, but that didn't change the outcome.

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I agree that this needs to be dealt with at a higher level than individual staff nurses. The meeting between family and the facility administrator and medical director sounds like the best way to move forward to me.

And meet sooner rather than later.

And don't just criticize the blanket, discuss her fears and knowledge, try to include the patient, and don't forget frequent ROM, as another poster stated.

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This whole deal with these people is because WE have again chosen to swing from one extreme to the other.

**

The blanket may not be preventing any contractures, but we also know for a fact that it is not doing much at all to restrict the movement of (restrain) this patient. So then this issue has become one that is creating distrust and animosity for absolutely no reason whatsoever. I'm glad they were allowed to have the blanket; it would matter not one bit to me as a nurse whether it was preventing contractures or not at this point. It clearly represents another aspect of this couple's life right now...it's part of this woman's grieving process, quite frankly. It must be so sad to prepare for saying good-bye to your life partner...

He might live a long, long time as a semi-invalid. Still, you make a good point.

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I agree. When she threw a huge tantrum late last night and said she wanted the blanket or she was calling the police or the news, the administrator just said to go ahead and let her have the blanket. The nurse documented everything in detail. We checked on the resident this morning and he had the weighted blanket on and his leg was drawn up (how he wants it!) and the blanket is preventing absolutely nothing as we suspected it would NOT. It's the most ridiculous suggestion I've ever heard to prevent contractures. The man moves his legs fine. The wife even came up to the facility right before midnight to make sure the staff didn't take it off of him.

The Administrator and DON and Medical Director need to put IN WRITING that the blanket is OK to use. Is the Admin an RN?

Did the "do not use" decision get put into writing? Naturally, the nurses are caught in the middle.

I wonder if the blanket makes the patient roasting hot. It sounds awful.

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His cheeks were red yesterday and his nurse asked him if he was hot and he said no.

The Admin is not a nurse, no. I'm not sure that the wife wants to use it anymore. She asked to have it removed from him last night. She said she's really stressed out with his health situation and won't have any money when this is all over. :( :( :(

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Specializes in Critical Care.
You or I or anyone else may believe that, but the OP has stated that the state licensing/regulating agency has already determined that it is a restraint, and that's who the facility has to answer to. The federal and state definitions of what constitutes a "restraint" in healthcare settings are v. broad. I used to work as a surveyor for my state and CMS, and I spent lots of time getting fancy explanations from facilities about why they didn't consider X, Y, or Z to be a restraint and therefore they weren't in violation of the regs, or they thought they had figured out some clever way to get around the regs about restraints, but that didn't change the outcome.

They asked whether a blanket which was described as movement restricting was a restraint, which it would be if it restricts movement since that is what defines a restraint. As it turns out however the blanket does not restrict movement, which makes it not a restraint.

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Specializes in Critical Care.
Why not simple range of motion??? She's obsessed with the blanket now. It feels very "control issue" motivated now... I'm not sure what is driving her so hard about it.

It make help to try and look at it from an outside perspective and consider whether the push to use the blanket is the only "control issue" involved.

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1. Is it possible that the wife misunderstood the rationale behind the weighted blanket? For example maybe the hospice nurse told her to use rolled washclothes to prevent contractures of the hands, and the weighed blanket might be soothing.I can only imagine under that level of stress that info might have been misunderstood.

2. I work in hospice and weighted blankets are NOT considered restraints where I work now, nor were they considered a restraint when I worked in pediatrics at a leading peds hospital. They were very often used on the chronic kids and the kids found them comforting -- and not just autistic kids.

3. Weighted blankets are very soothing and therapeutic for many people for many reasons, not just autistic people. Sometimes my patients enjoy a few heavy blankets for the security. Heck, I have a weighted blanket myself and it helps me fall asleep when I have insomnia!

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I have a weighted blanket too... to help me sleep better... She was told to use it to use it to specifically prevent contractures. Our facility is not a hospital or a home. It's a nursing home and our regulations are MUCH more rigid because we are taking care of the elderly in a long-term setting. She wanted it to RESTRICT movement. She has since decided not to use it because it was pointless. The man is not anxious. She needs the blanket for herself, honestly. I'm not trying to be sarcastic. She needs something for her own anxiety. This man is and was fine without the blanket. People in our facility can't even have a lap tray on their chair as it's considered a restraint by the state surveyors. There are a lot of things in long-term care that are NO NOs that you would never dream of them being in another facility... yet the state frowns upon them. So... welcome to my world. LOL

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This man is not a pediatric patient nor is he a young adult with autism or anxiety issues. He's a hospice patient in a nursing home and we have regulations and rules. Our people are frail and this 16-lb blanket puts him at risk for skin breakdowns and foot drop and it's UNnecessary. :(

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But... the wife wanted it to be used to restrict his movement. It was the whole IDEA of weighting his leg down so not to allow him to bend. That's mean and unnecessary, albeit misguided and misinformed... but was told to do this by a medical professional and I've no clue why. He doesn't have anxiety or insomnia.

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