XL Humane blanket?

Jules A, MSN · May 6, 2011

We aren't allowed to use these and instead have to escort the patient to the quiet room.

pandora44 · May 8, 2011

So what do you do when the pt is assaulting staff by bitting, kicking, punching, rushing, etc.? Those are the only times we use the humane blanket, when we can't get the patient safely to the quiet room otherwise.

Davey Do · May 8, 2011

Hmmm! Can't use loking devices, eh, pandora44? What a bummer! I mean, really!

I had never heard of a Human Blanket before. Interesting concept. We use locking restraints at the Facility where I work. We often will take the Stryker-style restraint bed to the acting-out Patient, place the Patient upon it, and apply 4 or 5 point restarints.

I'd really like to learn more about your situation and techniques. I have a sense that your way may be in the future for us. Who knows?

I wish I could help, but this is out of my arena of experience.

The best to you.

Dave

Jules A, MSN · May 9, 2011

Nope no 4pt restraints either. It can be pretty ugly although I really don't have fond memories of using 4pts. I haven't ever used safety coats or any others so your post perked my interest. Staff escorts them, swinging, kicking, spitting and screaming to the quiet room. In most cases they also have to hold them while I give an IM and at that point they release the patient one by one, run out and lock the door. It gets really sticky if they are self injurious and we have to go back in but then again the staff just holds them standing up and prevents them from injuring theirself.

Whispera, MSN, RN · May 9, 2011

I have no experience with a Humane blanket either. Everywhere I've worked there have been pretty hefty velcro restraints and for the really difficult patients there was something affectionately called "the net." It was at least a 8-point restraint device that was put over the patient as he was on his back on the bed. I can't remember exactly since it was seldom used. It covered most of the body.

It seems to me that it would be more dangerous to the patient (to say nothing of to staff) for a patient to be held by people rather than by equipment...

Kooky Korky, BSN, RN · May 10, 2011

Is it like a straight jacket?

At facilities where no restraints are allowed - have staff injuries gone up since your place quit using restraints?

What about pt injuries?

Kooky Korky, BSN, RN · May 10, 2011

Nope no 4pt restraints either. It can be pretty ugly although I really don't have fond memories of using 4pts. I haven't ever used safety coats or any others so your post perked my interest. Staff escorts them, swinging, kicking, spitting and screaming to the quiet room. In most cases they also have to hold them while I give an IM and at that point they release the patient one by one, run out and lock the door. It gets really sticky if they are self injurious and we have to go back in but then again the staff just holds them standing up and prevents them from injuring theirself.

No manual hold either? How can you escort them if they are not at least manually restrained?

You must have lots of brave staff.

Mostly male staff?

pandora44 · May 11, 2011

When I first wrote this post I assumed that the Humane blanket was much more widely known that it obviously is.

Among the staff, the humane blanket is known as the "Burrito" and that image helps explain how it is used. The blanket is a large piece of heavy duty canvas with velcro that is used to safely transport an out of control patient. It cannot be used to restrain a patient, only to move them. There are two extra pieces of canvas about ten inches wide and pretty long. One of these goes around the pt's legs at the knees and the other around the pt's torso at the elbow. Both are secured with velcro. The pt's arms have to be inside this canvas strip. Once the two canvas strips are on the pt, it's fairly easy-ish to roll the pt into the blanket and secure them by wrapping it around them. There are six handles on the blanket to carry the pt.

As I mentioned in my first post, this works pretty well if the pt is of average size. With an obese pt, nothing fits. We spent 45 minutes the other night trying to move a pt through two doors and ten feet to get her to a bed to be restrained. We sort of got her in the humane blanket but she was too big for it to fit properly. She was also kicking, clawing, bitting, punching, and causing as much havoc as possible.

This is an interesting discussion and I am curious to hear about other's experience of restraints. We heard earlier this year that our hospital system is considering doing away with restraints completely but even our director said that was not likely to happen. I, too, never like to restrain patients. However, I think that it is sometimes necessary and I feel confident that in my facility restraints are only used when a patient is a clear danger to self or others.

Jules A, MSN · May 11, 2011

no manual hold either? how can you escort them if they are not at least manually restrained?
you must have lots of brave staff.
mostly male staff?

manual holds, we have to be brave and whenever we complain that we need more males on the unit it is met with the politically correct bs about women being just as valuable as men. while i agree that females have great value to the team there is no comparison to the deterrent provided by having a few imposing male figures on the floor or the muscle to swiftly "escort" them to the quiet room.

kooky korky, it does't appear the numbers of injuries to either patients or staff have increased with this method however the times we don't have enough control over the milieu related to inadequate staffing it is my feeling that the injuries that do happen are more severe than in the past.

IMustBeCrazy · May 11, 2011

I'd be long gone from that environment. Your facility is not providing safe and proper resources, monitoring or policies for milieu control. Is it any wonder that your unit is experiencing a spike in acting-out behavior? It has become sport for your patients to see who can win the acting-out contest.

I find that the administrators that advocate the fluffy hands-off approach are the same ones that haven't been out of their office for several decades. Restraint policies, when properly (and rarely) used, keep both patients and staff safe.

On the other hand, I will also say that the greater than 50% of the time if you have to resort to quiet room, you've had insufficient careplanning and behavioral contracting with that patient. Our job is not to be the Behavioral SWAT team. Our goal should be to work with the patient to provide an environment of trust where patient and staff have similar goals to recognize and intervene in behaviors before they are out of control. Does your intake process require that you ask the patient 1) what types of triggers cause behaviors and 2) what their beginning upset looks like? Have them describe this to you in their own words, and don't accept generalizations like "I get ****** when people are yelling." Ask them, "how would I, as someone that does not know you, observe that you are becoming upset?" Drill down for specifics, focus on the cues that come prior to an outburst such as tapping their fingers, red-faced, staring at a wall, pacing in the hall, swearing, crying, sitting by the nurses station, isolating to their room, etc. Careplan it, assist them in recognizing their cues, provide alternatives such as 1:1 time with staff, listening to music/a calming solo activity or PRN medications and ultimately hold them accountable for their own behaviors.

Above all consistency, consistency, consistency from shift to shift! If you don't take the time to careplan it, then don't be upset when the next shift does something completely different and derails the structure you have initiated.

Lastly, since you are having such high unit acuity, it also sounds like your manager should be helping to provide you with extra staffing for the short term. There needs to be extra eyes and ears down the halls to provide a calming influence and to redirect minor behaviors that escalate quickly if unaddressed. If they balk, remind them that paying an extra person for a couple days is much better than having to explain to Joint Commission on their next survey why they had 10 restraints in 2 days!

pandora44 · May 12, 2011

When I posted my original comments I was quite frustrated and tired and simply needed a few sentences to vent. I neither expected nor asked for responses about acuity. The implication that the nursing staff is responsible for patients acting out and that management was lax in their responsibilities is misplaced considering I offered no information about the clinical situation of the patients involved, or the unit's policies or procedures (other than that we use restraints), or management's response to the situation. I would hope that a fellow nurse would respect the clinical judgment of experienced psychiatric nurses who actually knew the situation.

For the record, and as I originally stated, multiple codes in a night is not normal for my unit. We frequently go weeks without any codes at all. Additionally, calling a code does not mean that a patient is going to be restrained. It simply means that the RN wants extra staff members available and, if possible, we call codes before a patient loses control.

We do assess for patient triggers and coping skills that work for them on admission to the unit. We do care plan that. We do strive to provide consist limits for patients. We are not ignorant of the fact that patients do up the ante, as it were. Nor do we think of ourselves, or act, as the Behavioral SWAT team. And incidentally, management closed four beds for us and provided extra staff, all without prompting from staff, while our acuity was high. Since my original post, we've had no codes at all.

What we do as psychiatric nurses is so challenging and difficult. It is also terribly misunderstood by the general public and misrepresented by the media. We have so few avenues to talk freely among ourselves about the more difficult aspects of our work, i.e. restraints, seclusions, ECT, ect. I had hoped that the psychiatric nursing specialty pages of allnurses could be a space for us to communicate freely without the need to defend what we do and how we do it. I am truly sorry that has turned out not to be the case.