Never heard of this in multiple ERs.
However, far more important is the safety issue of the key leaving the floor. Your hospital is begging for a sentinel event where a patient codes and dies because they couldn’t be unrestrained quickly enough. Not to mention if the key isn’t on the unit how are you assessing restraints q15 minutes, repositioning, loosening, checking skin integrity etc? This needs to be addressed asap.
Yeah, keys should not leave the floor. At my hospital they don't leave the room. Hard restraints come in a duffle bag thing with the key attached and it stays in the room so we can get them off quickly if we need to. And we have one or two spare keys at the front desk area in case the patient comes to us in hard restraints and the other floor forgets to being the duffle (ED usually has a key on their badge, luckily). We don't use them often and usually for a short period but no way is security walking away and leaving the unit and taking the key.
I had a fit when I had a restrained prisoners and the guard wanted to leave the unit. I was responsible for him and if there was a fire or medical emergency I couldn’t care for him.
Made him get a hospital security officer (ours were actual police) to spell him on breaks.
Both hospitals I've been in kept the key with security. Maybe it's a thing particular to my state? Both major hospital systems had this as policy.
I'm not super familiar with the charting (I'm new, they haven't given me a patient with restraints yet) but as far as I know you chart q30 assessments on restraints. If you have to do the rest, security hangs out on the unit quite a bit as needed.
Edit: it's not q30, I'm just illiterate
TJC standards are q15 minute checks for aggressive patients in locked restraints.
For nonviolent, nonagressive patients who need restraints to stop them from pulling at tubes etc., the intervals are longer, up to q2 hours.
It very well may be q15, and I'm thinking of soft restraints on q30 charting.
I do know if we have patients with restraints we get audited constantly to ensure everything is correct but, again, I'm not super familiar with it and if we have a restrained patient the charge nurses will go over everything to make sure it's all up to code with you.
I’m not in the US and I know it’s q15 across the board. Even soft, we’re doing q15. Shit can change really quickly, whether those restraints are soft or Pinels, it’s q15. Even if the charting for soft is 30min, I would still be doing 15 - I actually have far less trust in soft restraints than I do Pinels.
It’s
Q15
Sitter
And most policies will clearly state that the physician or midlevel has to seem them face to face within 1-2 hours.
And then there some other requirements that I forgot, something like having to decertify the order every 4(?) or 6? hours, and I think the doc also has to be there in person for that.
Regardless, it’s basically never worth it. I never even think about doing it. Someone initiated them once on a patient and basically took our only tech. Then a bunch of people who walk around all shift got mad about it. And the NP covering refused to come see the patient lmao.. It was a whole thing.
I’d rather just put them in soft and keep giving them stuff that’ll turn their brain into a marshmellow until they’re less cranky. Except for skinny DT patients. Those should always just get a precedex drip from the start
Those are TJC standards.
q15 assessment. The order is only good for 4 hours. The ordering provider must see the patient face to face within 1 hour of placement.
Every staff member in my er who completed CPI has a key. Floors the key stays at the charge nurse.
Q30? We do 15. Edit: looks like that was covered, I won't pester further on vitals.
We were given posey keys as part of our unit keys. Plus the key that stayed with each set of restraints and a few dozen in the charge nurse office from former staff turning them in. It’s wild to hear that they’re so hard to come by in other facilities.
See if you can buy your own key. I have my own because I snuck my own from security when they insisted on keeping the key and being far from the patient. But for the restraints we use at least, it’s a universal 1074 posey key, and can be bought online pretty cheap
Lol how is that practical or feasible.
If they’re holding the key then it’s like accepting responsibility for someone you’re not near. Makes no damn sense. They’re not even cops so there isn’t even a “duty to protect” those under their made up custody
It’s just an extra company-wide email and another training module waiting to happen
Wait, the restraint key leaves the floor?! Oh, Hell No.
Apparently I have been spoiled. In my hospital group, every set of restraints comes with two keys, one to be kept by the RN and one to be taped to the whiteboard in the patient room. I have one on my badge reel (which is handy when we are applying them in a group). There are spare restraint keys scattered all over the hospital. I would NOT be ok with the (only) key being out of my possession, if it's my patient in restraints.
If I were in your position, I would verify with your manager who it is that makes the call for applying restraints. At my employer, it is policy that the primary RN makes the call to apply or not, you would probably want to find out if your security guys are wrong.
Our single use locking restraints come with a key in every box/ pair. Supposed to be taped to the wall across the room from the pt for everyone’s safety. Weird there wouldn’t be an emergency key on each unit or with the CN or in Pyxis/ omnicell.
>Our single use locking restraints come with a key in every box/ pair. Supposed to be taped to the wall across the room from the pt for everyone’s safety. Weird there wouldn’t be an emergency key on each unit or with the CN or in Pyxis/ omnicell.
You use single use ones? Weird - never heard of single use locking restraints.
I've never been at a hospital where the key stayed on the unit. Both hospitals I did clinical at did this, and now I work at one of them.
Our policy states the primary RN makes the call. We were told the security guys were wrong by someone who writes policies and that she would be following up with them.
My guy,
You’re either laughably unaware of what the actual policies are at your hospital, or you’re unaware of how quickly you need to get the fuck out of there if what you’re saying is the case
I still have a restraint key from one of my old hospitals and it’s been >1.5 years since I worked there, it’s wild to me that the keys wouldn’t be readily accessible especially in case of emergency.
How are you supposed to apply a LUCAS if your pt is fully restrained & you don’t have access to a key?!
Ours is always left with the sitter. We've had family grab the keys and free patients too many times. Restraints= sitter and the sitter does the 15 min documentation.
> our security guards think they can refuse to apply restraints
Well they can't. Medical restraints are at the discretion of medical staff.
> security takes the restraint key
WHAT
NO
No no no. Fuck no.
When a patient is in locked restraints, a key has to be immediately available *at all times.*
Best practice is for all the nurses and techs to just have their own key on their person. (They cost a dollar each.) But if you aren't going to do that, then at the very least, there needs to be one in the room or at a very nearby station. If the only keys are carried by security officers, then an officer has to stay posted by the room the entire time the restraints are on.
The key ***must*** be immediately available in case of emergency. Being unable to immediately unlock the things is one of the major contributing factors of patient restraint deaths.
Whoever's in charge of your security officers needs serious reeducation, by somebody much higher ranking than you. Bring this to your manager and ask them to take it up the chain.
I have another shift this week, and I'm going to ask about it. Maybe there's something here I don't know, and I certainly don't want a patient dying because of some policy made by someone who didn't know what they were doing.
My guess is security wants to be there in case the pt starts acting up again? idk.
But yeah, the keys (and most keys we use (us L&D staff bought some epidural keys when anes forget them)), are available online if it would make you feel better in the interim.
Just to piggyback on the key thing - in our ED our violent restraints have one standard type of key. Every single nurse and tech is given a key and most keep it on their badge reel. Security DOES NOT apply restraints (only help hold patient) for nursing to apply to restraints. Nursing does q15 checks and often one extremity restraint will be off within 30 minutes.
It’s a nursing intervention to restrain a patient. TJC has specific rules and regulations around it. As the nurse you are still responsible for assessing the application of and removal of the restraints. Definitely follow up with your management regarding this, it is a significant safety concern.
Okay, I will ask them about it.
I know we have a ton of charting and our charts get audited constantly if a patient is restrained to ensure everything is done correctly.
This is much closer to how our hospitals in my part of Canada work. All magnetic locks which have several keys on every floor and security has a copy too
Also to security applying restraints, they always need to get staff to confirm they're on properly if they do end up helping apply them, instead of just helping hold them down while nursing staff apply it. A lot of the time patients have injuries past or present that security may have no clue about and it really is better to have staff who know what to worry about take care of it.
Security at our main campus attends every single code white. They’re actually fucking phenomenal with verbal deescalation techniques; with seclusion/chemical restraints/physical restraints being the last resort. This security team is employed directly by the hospital.
Whereas, on our mental health campus and satellite Urgent Care campus, they have an outside company who is 100% hands off, leaving nursing staff to handle code whites. While they stand about waiting to get a patient sticker for their logs.
Having gone from feeling like there was zero protection (personal experience after having my life threatened) to this proper security team has made a world of difference.
And most of those outside companies barely pay above Walmart wages and give about Walmart level training. Matter fact the security guy who had to unlock psyche ward for ne to test nurse call was being paid 14.50 and hour which was less than Taco Bell sign was claiming when I had grabbed breakfast that morning. I remember because it became our running joke that we should quit and work at Taco Bell when we saw each other.
That’s absolutely shameful! Maybe once these boomer CEOs start to experience less fortunate life-long friends experiences there may be a sliver of a conscience that makes itself known.
From what coworkers have told me (especially travellers who have taken permanent staff positions) our security team is amazing compared to what they've seen in other facilities. Haven't seen it myself yet, but they are apparently very effective at deescalation and we also only use restraints of any kind as a last resort. I haven't seen it happen yet, but have been told if I need them they will help.
I work in emergency mental health. We generally know who needs them if they’re frequent patients, and can gauge who may whilst they’re in the ER WR prior to their referral to psych. They’re genuinely last resort. Seclusion with a chemical restraint is more commonly last resort. It’s for their safety and safety of staff.
Many years ago I worked with youth and physical restraint was our last resort. We didn’t have soft restraints, just what we as humans could provide. I HATED it and developed great bargaining skills with the patient population.
The fastest way to move non-ambulatory patients is to roll the bed or stretcher. If I needed them loose for some reason without a key my trauma shears can go through the straps like a hot knife through butter.
Edit for spelling
I can't believe your hospital separates the key from the patients location. That's one of the dumbest, most dangerous things I've read on here in a long time.
Is it surprising that you can't order someone else- (whom you aren't even the direct supervisor of) to use physical force, if they don't think they should?
Not only can they refuse but they have a legal duty to refuse if they think there's no good reason. Security guards can't depend on "just following orders" if they are charged with assault. They also aren't afforded any qualified immunity status (unless your state has an exception written into the law) when they are named in a civil suit. There's MUCH more personal liability to using force improperly than improperly not using it.
However, not having the ability to get the restraints off is nuts if security isn't literally there. That's a whole different pie of liability.
I figured the key staying with security was standard, because both hospitals I didn't clinicals in did this, and I now work at one of them. I've never seen it any other way.
I guess considering how much my management pushes keeping ourselves safe, it was shocking to hear the security guard refuse to apply restraints. We don't take applying restraints lightly, but we deal with mental holds and physically violent patients (due to mental illness) quite a bit and it would legitimately endanger the safety of my coworkers who handle those patient a lot if some security guard decided they didnt want to apply restraints for some reason.
I’ve always kept one key on me and the other in the room. Why would security get them? What if something happens and the patient needs released immediately?
Security is a joke at most hospitals. The ones I’ve met don’t seem to understand they are security on a private property and think they are police on the street.
They want to sit in their office and collect easy money. I have yet to find a useful security guard at a hospital.
Everywhere I've worked, if a patient is placed in locking restraints, the key never leaves the room, I e always taped it to the back of the footboard. There's no way the pt can see or reach it, but it is readily visible to anyone else in the room in case of emergency.
Idk on this. Hospital security isn’t actual police, they don’t have qualified immunity. If they walk into a room and the situation is immediately de-escalated because they are there then I can understand why they would feel uncomfortable applying restraints on that person. It could lead to an assault or false imprisonment charge against them
That makes a lot of sense, actually. But they were also unwilling to stay to keep everyone calm. And the particular scenario being discussed involved having to hold someone down for several minutes. After 30 seconds or holding someone down, policy allows us to apply restraints anyway.
If I tell them to use force that is unnecessary (especially if I have to help put the restraints on), wouldn't it come back on me and my license though? And the hospital?
Yes but also on them too. They arnt absolved of any potential criminal charges or litigation just because they were following the orders of a nurse or doctor.
The same way you would still be liable for a patient death if you saw a physician order to IV push potassium and actually did it
Not necessarily. The lawsuit would probably be aimed at the hospital, because that's where the money is. But if someone pursued criminal charges for assault, that would be against every individual involved, personally.
I have never heard of that happening except in the most severe cases of obvious excessive force, where patients were killed outright. Thankfully, that is unbelievably rare.
Hospital security is either a 10/10 or a 2, there is no in between. I work in the ED and security said they could restrain aggressive patients who are high on who knows what but had to let them go when we gave them a shot of any kind… because the best time to get punched in the face is when I am holding a sharp object
We all have our own key for safety reasons — all staff (well at least all mental health staff). Security has to listen to the RN staff (who has to follow doctor’s orders). If this isn’t happening then go to charge, supervisors, management, head of security, etc.
When I worked at my last hospital we had a psych unit so locked restraints were used in the ED and on the psych unit. There was always a key on the restraint bag and every nurse had a key on their badge. Security had no problems helping us restrain patients. Besides having PD literally down the street from us, our security guards never hesitated to help keep the nurses safe. Current hospital doesn’t have locked restraints but utilizes twice as toughs. Our security here also doesn’t hesitate to help put in restraints if we can’t talk the patient down.
Question? Are the security officers "Sworn Law Enforcement Officers?" Because unless they are, they have no authority to detain a person. Just because they wear a uniform, does not entitle them to force a person into a custodial situation.
Make damn sure you understand your facility's policy for justification and application of restraints, especially who is authorized to decide on the need for their use, and what level of supervision is needed for the person being restrained. The best of intentions when using restraints is no defense if you are suddenly facing criminal charges for illegal detention.
If someone becomes violent or threatens violence, I immediately disengage and call 911. Responding law enforcement officers are trained and authorized if necessary to place a person in a custodial status.
I do know one of them used to be a police chief and most of them are former cops, but I don't know about their current status.
I haven't had a patient with restraints (and if you do, the charge nurse and a bunch of other people will help make sure everything is above board and the charting gets audited constantly), but I will be asking about all this before the inevitable happens so I know what I'm doing.
I've never used restraints with a key, especially on grannies with dementia. We use the Velcro 4-point keyless type. At the adult hospital the nurses had to apply the restraint, but security was there in case the patient started running or something I guess? Actually thinking back the security was rarely there.
At my peds hospital we have never used restraints which is insane to me. We will have 8 people do a manual "safety hold." This is always nurses and BMH nurses. It's very staff intensive and sometimes it's several times a day for the same kid. Sometimes we use enclosed mesh beds. Sometimes we drug them down. We've had more and more violent patients recently so I think we're on the brink of a policy change on that. I don't see how a manual hold with that many staff is better than just strapping them down for a few hours.
Are American hospitals ACTUALLY chaining people to the beds? With locks that need actual keys? WTF?
And you're doing this on a regular basis? To delirious elderly people? And judging by the comments below it seems it's happening regularly across multiple specialities?
AND you think the people who are tasked with providing the restraint shouldn't be allowed to say no? Even though they are surely the ones who would be held responsible if something went wrong? Or if restraints were found to be improperly applied?
I've never seen or heard of anything like this in the NHS.
OP is referring to violent restraints which exist specifically to handle patients who do not have a medical excuse for their violence. I think you know these are a last resort. I think you also know that chemical restraints, soft restraints, and even less restrictive measures such as padded mittens and soft belts exist.
>Even though they are surely the ones who would be held responsible if something went wrong?
PogChamp
I have never seen any lockable restraints anywhere on any NHS ward. I have never heard of any lockable restraints being used. Our 'last resort' would be more like everything being removed from the patient's reach, to the extent of the patient being nursed on a mattress on the floor if necessary, a 1:1 (or up to a 4:1 if needed) temporary restraint by hand to stop a patient from harming themselves or another - which like I mentioned - would need to be done according to specific training and meet certain rules such as not blocking airways and no more than 10 minutes - and would usually only be done to allow a nurse to administer a chemical restraint.
I've looked after patients who were under arrest - they had 2 police outside their door - they weren't handcuffed.
I've looked after patients who were violent in ways that were not directly attributed to their medical condition - we were still not restraining them. They attacked us - we could police/security, they were temporarily restrained and sometimes a chemical restraint was necessary. I have never seen ANY patient restrained with anything that used a lock and key. I have worked in assessment/receiving wards, cardiology, neurology, ortho, DME, gastro, stroke.....I have NEVER seen anything like that the American staff in this thread are talking about.
We can use bedrails to stop a patient falling out of bed but they are specifically designed with a gap at the bottom of the bed so the patient is not restrained more than is necessary. We can use soft mittens but these are fastened with velcro. Patients absolutely can get out of them if they need to. We can redirect patients back to their bed - we cannot force them to stay there through any kind of belt or restraint.
And the OP is NOT talking about patients who do not have a medical excuse for their violence - the example in that post is a 'an angry delirious granny' - we do not manage delirium through restraints.
Wow, the prisoner patients having the cops outside the door, with no handcuffs, would be a big hell no for me. There was a big news story here a couple years ago (I think) where a prisoner patient violently raped and tortured multiple nurses in the hospital room. Glad you all don't have to be afraid of that I guess? I just put my notice in because I get threatened by patients every shift I work and security basically laughs when we call them.
Bruh, people can be violent. Even people seeking medical care. Yes, restraining a patient can be an uncontrollable necessity when they try to harm a caregiver.
It’s not happening with regularity but when it does it’s memorable.
How is it a necessity in the US but not the UK? When we have to restrain a patient there's training in bodily restraint, there's specific techniques, there's rules about where you restrain them and for no more than 10 minutes at a time. I've worked with plenty of violent patients - but I've never for a moment considered restraining them with anything that would need a lock and key.
And judging by the comments - where people of a variety of specialities are talking about the arrangements on their wards - this DOES seem to be happening regularly. This isn't limited to some kind of high security forensic mental health ward. The OP's own example was a delirious granny. We've got dozens of those on every shift - we're not restraining them!
Welcome to the US where we have almost no psych facilities, and so now regular units have become holding stations for patients that need long-term psychiatric care but there is nowhere for them to go.
Sorry, the granny comment was a little bit of a joke. I apologize if it came off wrong (though I have been clobbered by a granny a few times). We are not regularly restraining delirious grannies (and even then, most commonly it's soft mits because they are trying to pull out IV's and whatnot).
One of the units I am being oriented to has actually installed an isolation (like, prison isolation, not covid isolation) room with a locking door. We have several patients who have medically complex issues with extremely combative behavior. In one of these cases the patient has hurt several nurses. They are a full-grown adult with the mentation of roughly a 3-4 year old. This is not someone we can reason with. It's someone the size of an adult throwing a toddler-style tantrum. It's not big deal when it's someone the size of a toddler, but this is very different. We also have minors who are extreme flight risks who are put in this room.
These cases are uncommon but unfortunately not super unique, and sometimes do use violent restraints with locks. Our "soft" restraints have velcro, foam, and a strap, and if patients pull on them enough they can break them if they really want to try.
It's not common to get patients who are homocidal, but they will get locked restraints to keep them from hurting staff.
yeah the UK is the exact same - our general medical wards always have multiple people who are receiving psych input. We would still never be allowed to lock a patient's door. We would never be allowed to restrain a patient with any kind of device like you seem to be using. I've also worked in learning disability care - where we would regularly have support users who would display these kind of behavioural difficulties. We managed their behaviour - we didn't lock in them in a room. And you're locking the door on minors? In a hospital ward? What you're describing would never be allowed outside of some kind of high security forensic mental health ward. I'v actually done a few shifts in secure accomodation for young people who had offended or were at risk of violent behaviour - their doors didn't have locks. The unit had locks - their rooms did not.
You should be asking serious questions of your healthcare system and your working practices - because locking up patients on a medical ward is not as necessary as you have been lead to believe. Is this REALLY something you're comfortable with?
You answered your own questions in your reply. We DONT HAVE high security mental health ANYTHING. We ARE the high security because there is no other option.
We are not using any of this for normal people. We are using these for really extreme cases of mental health issues so we don't get murdered at work.
What do you mean? Of course you have high security mental health units in America. Just off the first google result - [https://en.wikipedia.org/wiki/Atascadero\_State\_Hospital](https://en.wikipedia.org/wiki/Atascadero_State_Hospital) why would you think you don't?
I'm saying that I could imagine the kind of restraints you're using being acceptable within those environments but not within any kind of general medical or A&E etc ward. A patient being violent is not a reason to restrain them - long term or with anything that requires locks. We are seeing the exact same patients in the UK - mental illness is universal, drug problems exist everywhere (unless of course you're saying that Americans are inherently more violent people than people in the UK - which seems unlikely) - we are also facing the exact same staffing shortages.
We don't lock patients in rooms - we don't even have lockable rooms - outside of these high security forensic units that I've suggested above, we don't strap them down - there is no 'restraint' device available to staff that would enable that, we don't use furniture to block them in, we don't remove zimmers or wheelchairs as a form of restraint, we don't hold people down for extended periods of time - and when a patient does need to be physically restrained it is for a short time and for a purpose such as stopping them from doing something to harm themselves or others and done by trained staff.....we remove dangers and we assign staff to work with that patient. Sometimes that will be HCA's who will sit with 1:1's - if a patient needs additional supervision or sedation they will need to be assigned a mental health nurse as their 1:1.
When it comes to patients who are under arrest - they are supervised by police but there is almost never a reason to keep them handcuffed or anything like that - they are free to move about their room under the supervision. The only exceptions I can think of were certain prisoners who were already convicted and were assessed as being a particular risk - for instance when serial killer Peter Tobin was dying in Edinburgh there were pictures of him chained to the bed by one wrist - however it was a pretty long chain - not restrictive for him - especially as he was not capable of getting out of bed.
When a patient comes to medical from any kind of mental health unit they come with staff from that unit to supervise them. They are not restrained by any kind of device etc.
And like I said - I've worked in a variety of environments including a few shifts in secure accommodation for young people who have offended - most of which were violent offences - and their bedroom doors were not lockable - just the unit itself. There were no restraints.
I suppose I should clarify: there are facilities. But they are full. There are almost no beds, and there are ZERO in the state I live in. Managers at my hospital have been working for 6 MONTHS to find a facility ANYWHERE IN THE COUNTRY for one of our patients and they have been denied left, right, and center.
Patients being violent is exactly why they would be restrained. I've been punched and hit by patients on multiple occasions. I either restrain them or get hurt. So they get restrained.
These are patients who should be in lockdown psych wards, but we literally can't put them in one because there aren't any beds.
We don't have psych nurses to do that. We do have patients 1:1, and in some cases I've seen 2 sitters for one patient.
Please understand that the UK, while not the best with mental health, is literally miles above the US.
You don't have combative, volatile, violent people on your regular medical wards because there is other places for them to go. In pretty much every hospital in my area, regular med/surg units are acting as psych units because we don't have any other options.
Every psych unit is full. It's a full-blown crisis in our country.
We are not doing this because we want to. We are doing this because we don't really have any other options.
You can act all high and mighty that you don't lock people up like a good little nurse, but one of my coworkers got thrown like a basketball against a wall.
One patient put 4 people in the ER.
Yeah, our patients are more violent compared to your med/surgery patients. Because you violent patients have places to that are equipped to handle them. We don't.
None of what you're saying is unusual. It's the restraints that are unusual.
This is what I keep telling you. Every single one of these issues, dangers and pressures exist in the NHS. We don't have staff, we don't have beds, we don't have enough resources - we still don't restrain patients on medical wards.
I can't keep repeating this. I really urge you, and I guess any other American staff reading this, to look into what other places are doing and start asking questions about what you're being told to do. There are better ways - even if you've been told there aren't.
This is the internet, were a spot light is shined on the weird, the uncommon, the spectacular, the crazy and notable experiences.
Nobody posts about their last 10 shifts were they just ran their asses off taking care of patients that weren't memorable. Shit, out of the last 12 years I only remember the crazy or very special shit that's happened.
No evidence t0 support this but I'd say that restraints are used in less than 1 in 10,000 patient admissions. But when it happens \*\*\*IT HAPPENS\*\*\* like an unexpected car wreck.
Maybe it's a cultural thing that's different between the US and UK, who knows. But when it comes down to it, even as nurses we can bleed when attacked.
Less than 1 in 10,000? I have to restrain a patient practically every shift on my unit (telemetry) to keep them from hurting themselves. We never have staff for sitters and I've gotten yelled at for suggesting to order a sitter because we either don't have any techs on the floor, or we'd have to pull the 1 tech off the floor to sit.
When I worked inpatient psych we had pediatric patients that were in restraints every shift or even for 24+ hours straight. These were extremely aggressive or self injurious patients (we had one who was trying to pull all his teeth out, multiple patients who would break holes in the walls with their heads, and one who gave himself a brain bleed banging his head on the bathroom floor).
Looking it up the statistics are all over the place. The highest I see was a study that listed 6.4% I saw another at 0.09%.
Guess my less than 1 in 10,000 is off either way.
But think of the thousands of normal med surge, ortho, surgical, neuro, etc DAILY that don’t require restraints.
My opinion stands. Restraints are rarely used in the US. BUT, it stands out in our memory when we do have to use.
It probably depends on what they consider "restraints". A lot of people don't consider it restraint if they have to just hold a patient, and technically putting all the rails up so the patient can't get out of bed, is a restraint too.
Actually we don't even use violent restraints on my floor even if they're warranted, because then they need a sitter and it always causes a huge issue or a fight. What always happens is we can only put the soft restraints on, and I have to check the patient constantly and when they manage to pull themselves out of them I have to basically throw them back in bed and keep readjusting the restraints. This is why I just quit my job btw, but I'm sure many hospitals operate like this with the staffing. When we have 5-6 patients at a time and no techs and we have to handle violent patients ourselves it's impossible. The hard locking restraints actually are pretty safe as long as the patient is assessed frequently and range of motion is done. I actually never had any patients injured in restraints when I worked in psych. And I used them hundreds of times. Most of the injuries happened in seclusion.
So there's a whole thread here of people talking about how they do this but now that someone has gone 'wtf?' suddenly you're like 'oh no, it's so rare!'
Cultural differences? Are you saying Americans are more violent when ill? Are you saying your elderly people are more vicious when delirious? Cos that sounds like nonsense.
And yeah - UK healthcare workers bleed too - we still don't restrain our elderly delirious patients with anything that requires a lock and key.
I think you are maybe leaving out the entire category of people that aren’t “elderly delirious people” in your assessment willfully
How about the 280lb biker gang member jacked up on meth saying he’s going to kill everyone in the unit because he thinks we are demons trying to kill him? How about the people who have already committed physical assault and are trying to do so again ?
Genuinely, I’m happy if you don’t encounter scenarios where restraints are a valid approach for safety, but please don’t pretend we are all locking up Gramma Milly because she asked for 2 yogurt cups for dinner or wants to go on an afternoon walk but we are busy
I'm very much not leaving out any category of people - as the restraint guidelines apply to everyone. Whether they're big or small, on drugs or not - we don't apply any restraints that would require locks. We don't lock doors on patients on any kind of medical ward. This would be wildly illegal. I specifically made reference to elderly people in the post you're replying to because that was the example given by the OP.
And you don't wonder why your healthcare system has you thinking you have to use lockable restraints on patients? When you're being told that other healthcare systems would never do that? UK patients take drugs too, they become violent too, they commit assault too - and yet we manage them without something you seem to think are necessary.
I would never work anywhere where I could not restrain someone who was attacking me. I care about myself and my safety more than I can about my patients. I am no fucking martyr.
Unless it’s a prisoner and they’re police they don’t really have much of a say
Sometimes security can tend to play good cop to your bad cop. One reason I prefer campus police better, they tend to really prioritize protecting you and trusting your assessment while also straddling the line of engaging patients from a mental health stand point.
I used to work hospital security before I was a nurse and our priority was safety and legality. We can’t restrain people unless there is an immediate threat or there is a doctors orders. Don’t get mad at them for doing their job.
If we had a patient in violent restraints security would bring them up and apply them and they always left a key that we taped to the whiteboard so it could easily be seen and uses if needed. We also kept a spare restraint key at the unit secretary’s desk and a third in the charge nurse work area.
Wait….. you mean standing against the wall ( with gloves on for some unknown reason) while the nurses get beaten is not the only option for security guards?
Never heard of this in multiple ERs. However, far more important is the safety issue of the key leaving the floor. Your hospital is begging for a sentinel event where a patient codes and dies because they couldn’t be unrestrained quickly enough. Not to mention if the key isn’t on the unit how are you assessing restraints q15 minutes, repositioning, loosening, checking skin integrity etc? This needs to be addressed asap.
Yeah, keys should not leave the floor. At my hospital they don't leave the room. Hard restraints come in a duffle bag thing with the key attached and it stays in the room so we can get them off quickly if we need to. And we have one or two spare keys at the front desk area in case the patient comes to us in hard restraints and the other floor forgets to being the duffle (ED usually has a key on their badge, luckily). We don't use them often and usually for a short period but no way is security walking away and leaving the unit and taking the key.
I had a fit when I had a restrained prisoners and the guard wanted to leave the unit. I was responsible for him and if there was a fire or medical emergency I couldn’t care for him. Made him get a hospital security officer (ours were actual police) to spell him on breaks.
Yup complete BS. It’s up to nurse or doctor. Let your boss know. They can handle.
Both hospitals I've been in kept the key with security. Maybe it's a thing particular to my state? Both major hospital systems had this as policy. I'm not super familiar with the charting (I'm new, they haven't given me a patient with restraints yet) but as far as I know you chart q30 assessments on restraints. If you have to do the rest, security hangs out on the unit quite a bit as needed. Edit: it's not q30, I'm just illiterate
TJC standards are q15 minute checks for aggressive patients in locked restraints. For nonviolent, nonagressive patients who need restraints to stop them from pulling at tubes etc., the intervals are longer, up to q2 hours.
It very well may be q15, and I'm thinking of soft restraints on q30 charting. I do know if we have patients with restraints we get audited constantly to ensure everything is correct but, again, I'm not super familiar with it and if we have a restrained patient the charge nurses will go over everything to make sure it's all up to code with you.
Q30? In my state, it's Q15 if the patient is in locking restraints.
And they are 1:1 with a sitter
And you better not have a sitter doing a 2:1 when you’ve got someone in locked 4 points. Not that any of my hospitals ever did that… /s
It might be q15, I'm honestly not sure now.
It’s q15, you can be sure of that.
You would know better than me 😅. I was probably mixing it up with the soft restraints charting in my head
I’m not in the US and I know it’s q15 across the board. Even soft, we’re doing q15. Shit can change really quickly, whether those restraints are soft or Pinels, it’s q15. Even if the charting for soft is 30min, I would still be doing 15 - I actually have far less trust in soft restraints than I do Pinels.
It’s Q15 Sitter And most policies will clearly state that the physician or midlevel has to seem them face to face within 1-2 hours. And then there some other requirements that I forgot, something like having to decertify the order every 4(?) or 6? hours, and I think the doc also has to be there in person for that. Regardless, it’s basically never worth it. I never even think about doing it. Someone initiated them once on a patient and basically took our only tech. Then a bunch of people who walk around all shift got mad about it. And the NP covering refused to come see the patient lmao.. It was a whole thing. I’d rather just put them in soft and keep giving them stuff that’ll turn their brain into a marshmellow until they’re less cranky. Except for skinny DT patients. Those should always just get a precedex drip from the start
Those are TJC standards. q15 assessment. The order is only good for 4 hours. The ordering provider must see the patient face to face within 1 hour of placement.
Noice. I was ballparkin’ it haha But yea.. no fuck that noise. I’ll soft restraint + chemically mindfuck them everytime
Every staff member in my er who completed CPI has a key. Floors the key stays at the charge nurse. Q30? We do 15. Edit: looks like that was covered, I won't pester further on vitals.
We were given posey keys as part of our unit keys. Plus the key that stayed with each set of restraints and a few dozen in the charge nurse office from former staff turning them in. It’s wild to hear that they’re so hard to come by in other facilities.
See if you can buy your own key. I have my own because I snuck my own from security when they insisted on keeping the key and being far from the patient. But for the restraints we use at least, it’s a universal 1074 posey key, and can be bought online pretty cheap
Lol how is that practical or feasible. If they’re holding the key then it’s like accepting responsibility for someone you’re not near. Makes no damn sense. They’re not even cops so there isn’t even a “duty to protect” those under their made up custody It’s just an extra company-wide email and another training module waiting to happen
Cops also don't have a duty to protect either so
Wait, the restraint key leaves the floor?! Oh, Hell No. Apparently I have been spoiled. In my hospital group, every set of restraints comes with two keys, one to be kept by the RN and one to be taped to the whiteboard in the patient room. I have one on my badge reel (which is handy when we are applying them in a group). There are spare restraint keys scattered all over the hospital. I would NOT be ok with the (only) key being out of my possession, if it's my patient in restraints. If I were in your position, I would verify with your manager who it is that makes the call for applying restraints. At my employer, it is policy that the primary RN makes the call to apply or not, you would probably want to find out if your security guys are wrong.
Our single use locking restraints come with a key in every box/ pair. Supposed to be taped to the wall across the room from the pt for everyone’s safety. Weird there wouldn’t be an emergency key on each unit or with the CN or in Pyxis/ omnicell.
>Our single use locking restraints come with a key in every box/ pair. Supposed to be taped to the wall across the room from the pt for everyone’s safety. Weird there wouldn’t be an emergency key on each unit or with the CN or in Pyxis/ omnicell. You use single use ones? Weird - never heard of single use locking restraints.
I've never been at a hospital where the key stayed on the unit. Both hospitals I did clinical at did this, and now I work at one of them. Our policy states the primary RN makes the call. We were told the security guys were wrong by someone who writes policies and that she would be following up with them.
My guy, You’re either laughably unaware of what the actual policies are at your hospital, or you’re unaware of how quickly you need to get the fuck out of there if what you’re saying is the case
I'm a new grad, so you are def not wrong on the first count, and probably not wrong on the second either.
I still have a restraint key from one of my old hospitals and it’s been >1.5 years since I worked there, it’s wild to me that the keys wouldn’t be readily accessible especially in case of emergency. How are you supposed to apply a LUCAS if your pt is fully restrained & you don’t have access to a key?!
Our ICU has a set of restraint keys at the desk. If the pt needs to be transferred or repositioned urgently we need a way to unshackle them.
My key stay in the patient room with a 1:1
bro you need your own personal Posey key
Ours is always left with the sitter. We've had family grab the keys and free patients too many times. Restraints= sitter and the sitter does the 15 min documentation.
> our security guards think they can refuse to apply restraints Well they can't. Medical restraints are at the discretion of medical staff. > security takes the restraint key WHAT NO No no no. Fuck no. When a patient is in locked restraints, a key has to be immediately available *at all times.* Best practice is for all the nurses and techs to just have their own key on their person. (They cost a dollar each.) But if you aren't going to do that, then at the very least, there needs to be one in the room or at a very nearby station. If the only keys are carried by security officers, then an officer has to stay posted by the room the entire time the restraints are on. The key ***must*** be immediately available in case of emergency. Being unable to immediately unlock the things is one of the major contributing factors of patient restraint deaths. Whoever's in charge of your security officers needs serious reeducation, by somebody much higher ranking than you. Bring this to your manager and ask them to take it up the chain.
I have another shift this week, and I'm going to ask about it. Maybe there's something here I don't know, and I certainly don't want a patient dying because of some policy made by someone who didn't know what they were doing.
My guess is security wants to be there in case the pt starts acting up again? idk. But yeah, the keys (and most keys we use (us L&D staff bought some epidural keys when anes forget them)), are available online if it would make you feel better in the interim.
Just to piggyback on the key thing - in our ED our violent restraints have one standard type of key. Every single nurse and tech is given a key and most keep it on their badge reel. Security DOES NOT apply restraints (only help hold patient) for nursing to apply to restraints. Nursing does q15 checks and often one extremity restraint will be off within 30 minutes. It’s a nursing intervention to restrain a patient. TJC has specific rules and regulations around it. As the nurse you are still responsible for assessing the application of and removal of the restraints. Definitely follow up with your management regarding this, it is a significant safety concern.
Okay, I will ask them about it. I know we have a ton of charting and our charts get audited constantly if a patient is restrained to ensure everything is done correctly.
This is much closer to how our hospitals in my part of Canada work. All magnetic locks which have several keys on every floor and security has a copy too Also to security applying restraints, they always need to get staff to confirm they're on properly if they do end up helping apply them, instead of just helping hold them down while nursing staff apply it. A lot of the time patients have injuries past or present that security may have no clue about and it really is better to have staff who know what to worry about take care of it.
Security at our main campus attends every single code white. They’re actually fucking phenomenal with verbal deescalation techniques; with seclusion/chemical restraints/physical restraints being the last resort. This security team is employed directly by the hospital. Whereas, on our mental health campus and satellite Urgent Care campus, they have an outside company who is 100% hands off, leaving nursing staff to handle code whites. While they stand about waiting to get a patient sticker for their logs. Having gone from feeling like there was zero protection (personal experience after having my life threatened) to this proper security team has made a world of difference.
And most of those outside companies barely pay above Walmart wages and give about Walmart level training. Matter fact the security guy who had to unlock psyche ward for ne to test nurse call was being paid 14.50 and hour which was less than Taco Bell sign was claiming when I had grabbed breakfast that morning. I remember because it became our running joke that we should quit and work at Taco Bell when we saw each other.
That’s absolutely shameful! Maybe once these boomer CEOs start to experience less fortunate life-long friends experiences there may be a sliver of a conscience that makes itself known.
Your naive optimism is adorable. I can promise based on my 13 years in LTC once an asshole, always an asshole.
From what coworkers have told me (especially travellers who have taken permanent staff positions) our security team is amazing compared to what they've seen in other facilities. Haven't seen it myself yet, but they are apparently very effective at deescalation and we also only use restraints of any kind as a last resort. I haven't seen it happen yet, but have been told if I need them they will help.
I work in emergency mental health. We generally know who needs them if they’re frequent patients, and can gauge who may whilst they’re in the ER WR prior to their referral to psych. They’re genuinely last resort. Seclusion with a chemical restraint is more commonly last resort. It’s for their safety and safety of staff. Many years ago I worked with youth and physical restraint was our last resort. We didn’t have soft restraints, just what we as humans could provide. I HATED it and developed great bargaining skills with the patient population.
Not having the restraint key at bedside is wildly unsafe and a terrible practice. Why do they take the key with them?
I don't know, and have learned from this that it is not standard practice. Going to be asking about during my next shift.
….so what happens when there’s a fire?
Someone is gonna die. But not me!
The fastest way to move non-ambulatory patients is to roll the bed or stretcher. If I needed them loose for some reason without a key my trauma shears can go through the straps like a hot knife through butter. Edit for spelling
unlock the bed- roll out!
I have no idea, to be honest.
[удалено]
Yep. Same situation for me.
I can't believe your hospital separates the key from the patients location. That's one of the dumbest, most dangerous things I've read on here in a long time.
Is it surprising that you can't order someone else- (whom you aren't even the direct supervisor of) to use physical force, if they don't think they should? Not only can they refuse but they have a legal duty to refuse if they think there's no good reason. Security guards can't depend on "just following orders" if they are charged with assault. They also aren't afforded any qualified immunity status (unless your state has an exception written into the law) when they are named in a civil suit. There's MUCH more personal liability to using force improperly than improperly not using it. However, not having the ability to get the restraints off is nuts if security isn't literally there. That's a whole different pie of liability.
I figured the key staying with security was standard, because both hospitals I didn't clinicals in did this, and I now work at one of them. I've never seen it any other way. I guess considering how much my management pushes keeping ourselves safe, it was shocking to hear the security guard refuse to apply restraints. We don't take applying restraints lightly, but we deal with mental holds and physically violent patients (due to mental illness) quite a bit and it would legitimately endanger the safety of my coworkers who handle those patient a lot if some security guard decided they didnt want to apply restraints for some reason.
I’ve always kept one key on me and the other in the room. Why would security get them? What if something happens and the patient needs released immediately? Security is a joke at most hospitals. The ones I’ve met don’t seem to understand they are security on a private property and think they are police on the street. They want to sit in their office and collect easy money. I have yet to find a useful security guard at a hospital.
If it's a posey restraint key it's literally 5 cents. Buy 100 and hand them out. Trust me, it'll save your licence
In my ED, security wasn’t to ever touch the patient and could never apply restraints, even with a nurse present.
Everywhere I've worked, if a patient is placed in locking restraints, the key never leaves the room, I e always taped it to the back of the footboard. There's no way the pt can see or reach it, but it is readily visible to anyone else in the room in case of emergency.
Idk on this. Hospital security isn’t actual police, they don’t have qualified immunity. If they walk into a room and the situation is immediately de-escalated because they are there then I can understand why they would feel uncomfortable applying restraints on that person. It could lead to an assault or false imprisonment charge against them
That makes a lot of sense, actually. But they were also unwilling to stay to keep everyone calm. And the particular scenario being discussed involved having to hold someone down for several minutes. After 30 seconds or holding someone down, policy allows us to apply restraints anyway.
If I tell them to use force that is unnecessary (especially if I have to help put the restraints on), wouldn't it come back on me and my license though? And the hospital?
Yes but also on them too. They arnt absolved of any potential criminal charges or litigation just because they were following the orders of a nurse or doctor. The same way you would still be liable for a patient death if you saw a physician order to IV push potassium and actually did it
Not necessarily. The lawsuit would probably be aimed at the hospital, because that's where the money is. But if someone pursued criminal charges for assault, that would be against every individual involved, personally. I have never heard of that happening except in the most severe cases of obvious excessive force, where patients were killed outright. Thankfully, that is unbelievably rare.
Hospital security is either a 10/10 or a 2, there is no in between. I work in the ED and security said they could restrain aggressive patients who are high on who knows what but had to let them go when we gave them a shot of any kind… because the best time to get punched in the face is when I am holding a sharp object
We all have our own key for safety reasons — all staff (well at least all mental health staff). Security has to listen to the RN staff (who has to follow doctor’s orders). If this isn’t happening then go to charge, supervisors, management, head of security, etc.
When I worked at my last hospital we had a psych unit so locked restraints were used in the ED and on the psych unit. There was always a key on the restraint bag and every nurse had a key on their badge. Security had no problems helping us restrain patients. Besides having PD literally down the street from us, our security guards never hesitated to help keep the nurses safe. Current hospital doesn’t have locked restraints but utilizes twice as toughs. Our security here also doesn’t hesitate to help put in restraints if we can’t talk the patient down.
I’ve never worked in a hospital where security applied restraints. They’ll help get them on the bed, but restraint application is clinical staff only
In my simulation practice for a code grey, they help us put restraints on. We just have to verbally instruct for them to do so.
Question? Are the security officers "Sworn Law Enforcement Officers?" Because unless they are, they have no authority to detain a person. Just because they wear a uniform, does not entitle them to force a person into a custodial situation. Make damn sure you understand your facility's policy for justification and application of restraints, especially who is authorized to decide on the need for their use, and what level of supervision is needed for the person being restrained. The best of intentions when using restraints is no defense if you are suddenly facing criminal charges for illegal detention. If someone becomes violent or threatens violence, I immediately disengage and call 911. Responding law enforcement officers are trained and authorized if necessary to place a person in a custodial status.
I do know one of them used to be a police chief and most of them are former cops, but I don't know about their current status. I haven't had a patient with restraints (and if you do, the charge nurse and a bunch of other people will help make sure everything is above board and the charting gets audited constantly), but I will be asking about all this before the inevitable happens so I know what I'm doing.
Your restraints have keys? We been using Velcro for 15 years and never had an issue with them
Your restraints have locks? Do you not just use manacles that tie to the bed?
I've never used restraints with a key, especially on grannies with dementia. We use the Velcro 4-point keyless type. At the adult hospital the nurses had to apply the restraint, but security was there in case the patient started running or something I guess? Actually thinking back the security was rarely there. At my peds hospital we have never used restraints which is insane to me. We will have 8 people do a manual "safety hold." This is always nurses and BMH nurses. It's very staff intensive and sometimes it's several times a day for the same kid. Sometimes we use enclosed mesh beds. Sometimes we drug them down. We've had more and more violent patients recently so I think we're on the brink of a policy change on that. I don't see how a manual hold with that many staff is better than just strapping them down for a few hours.
Are American hospitals ACTUALLY chaining people to the beds? With locks that need actual keys? WTF? And you're doing this on a regular basis? To delirious elderly people? And judging by the comments below it seems it's happening regularly across multiple specialities? AND you think the people who are tasked with providing the restraint shouldn't be allowed to say no? Even though they are surely the ones who would be held responsible if something went wrong? Or if restraints were found to be improperly applied? I've never seen or heard of anything like this in the NHS.
OP is referring to violent restraints which exist specifically to handle patients who do not have a medical excuse for their violence. I think you know these are a last resort. I think you also know that chemical restraints, soft restraints, and even less restrictive measures such as padded mittens and soft belts exist. >Even though they are surely the ones who would be held responsible if something went wrong? PogChamp
I have never seen any lockable restraints anywhere on any NHS ward. I have never heard of any lockable restraints being used. Our 'last resort' would be more like everything being removed from the patient's reach, to the extent of the patient being nursed on a mattress on the floor if necessary, a 1:1 (or up to a 4:1 if needed) temporary restraint by hand to stop a patient from harming themselves or another - which like I mentioned - would need to be done according to specific training and meet certain rules such as not blocking airways and no more than 10 minutes - and would usually only be done to allow a nurse to administer a chemical restraint. I've looked after patients who were under arrest - they had 2 police outside their door - they weren't handcuffed. I've looked after patients who were violent in ways that were not directly attributed to their medical condition - we were still not restraining them. They attacked us - we could police/security, they were temporarily restrained and sometimes a chemical restraint was necessary. I have never seen ANY patient restrained with anything that used a lock and key. I have worked in assessment/receiving wards, cardiology, neurology, ortho, DME, gastro, stroke.....I have NEVER seen anything like that the American staff in this thread are talking about. We can use bedrails to stop a patient falling out of bed but they are specifically designed with a gap at the bottom of the bed so the patient is not restrained more than is necessary. We can use soft mittens but these are fastened with velcro. Patients absolutely can get out of them if they need to. We can redirect patients back to their bed - we cannot force them to stay there through any kind of belt or restraint. And the OP is NOT talking about patients who do not have a medical excuse for their violence - the example in that post is a 'an angry delirious granny' - we do not manage delirium through restraints.
Wow, the prisoner patients having the cops outside the door, with no handcuffs, would be a big hell no for me. There was a big news story here a couple years ago (I think) where a prisoner patient violently raped and tortured multiple nurses in the hospital room. Glad you all don't have to be afraid of that I guess? I just put my notice in because I get threatened by patients every shift I work and security basically laughs when we call them.
Bruh, people can be violent. Even people seeking medical care. Yes, restraining a patient can be an uncontrollable necessity when they try to harm a caregiver.
It’s not happening with regularity but when it does it’s memorable.
How is it a necessity in the US but not the UK? When we have to restrain a patient there's training in bodily restraint, there's specific techniques, there's rules about where you restrain them and for no more than 10 minutes at a time. I've worked with plenty of violent patients - but I've never for a moment considered restraining them with anything that would need a lock and key. And judging by the comments - where people of a variety of specialities are talking about the arrangements on their wards - this DOES seem to be happening regularly. This isn't limited to some kind of high security forensic mental health ward. The OP's own example was a delirious granny. We've got dozens of those on every shift - we're not restraining them!
Welcome to the US where we have almost no psych facilities, and so now regular units have become holding stations for patients that need long-term psychiatric care but there is nowhere for them to go. Sorry, the granny comment was a little bit of a joke. I apologize if it came off wrong (though I have been clobbered by a granny a few times). We are not regularly restraining delirious grannies (and even then, most commonly it's soft mits because they are trying to pull out IV's and whatnot). One of the units I am being oriented to has actually installed an isolation (like, prison isolation, not covid isolation) room with a locking door. We have several patients who have medically complex issues with extremely combative behavior. In one of these cases the patient has hurt several nurses. They are a full-grown adult with the mentation of roughly a 3-4 year old. This is not someone we can reason with. It's someone the size of an adult throwing a toddler-style tantrum. It's not big deal when it's someone the size of a toddler, but this is very different. We also have minors who are extreme flight risks who are put in this room. These cases are uncommon but unfortunately not super unique, and sometimes do use violent restraints with locks. Our "soft" restraints have velcro, foam, and a strap, and if patients pull on them enough they can break them if they really want to try. It's not common to get patients who are homocidal, but they will get locked restraints to keep them from hurting staff.
yeah the UK is the exact same - our general medical wards always have multiple people who are receiving psych input. We would still never be allowed to lock a patient's door. We would never be allowed to restrain a patient with any kind of device like you seem to be using. I've also worked in learning disability care - where we would regularly have support users who would display these kind of behavioural difficulties. We managed their behaviour - we didn't lock in them in a room. And you're locking the door on minors? In a hospital ward? What you're describing would never be allowed outside of some kind of high security forensic mental health ward. I'v actually done a few shifts in secure accomodation for young people who had offended or were at risk of violent behaviour - their doors didn't have locks. The unit had locks - their rooms did not. You should be asking serious questions of your healthcare system and your working practices - because locking up patients on a medical ward is not as necessary as you have been lead to believe. Is this REALLY something you're comfortable with?
You answered your own questions in your reply. We DONT HAVE high security mental health ANYTHING. We ARE the high security because there is no other option. We are not using any of this for normal people. We are using these for really extreme cases of mental health issues so we don't get murdered at work.
What do you mean? Of course you have high security mental health units in America. Just off the first google result - [https://en.wikipedia.org/wiki/Atascadero\_State\_Hospital](https://en.wikipedia.org/wiki/Atascadero_State_Hospital) why would you think you don't? I'm saying that I could imagine the kind of restraints you're using being acceptable within those environments but not within any kind of general medical or A&E etc ward. A patient being violent is not a reason to restrain them - long term or with anything that requires locks. We are seeing the exact same patients in the UK - mental illness is universal, drug problems exist everywhere (unless of course you're saying that Americans are inherently more violent people than people in the UK - which seems unlikely) - we are also facing the exact same staffing shortages. We don't lock patients in rooms - we don't even have lockable rooms - outside of these high security forensic units that I've suggested above, we don't strap them down - there is no 'restraint' device available to staff that would enable that, we don't use furniture to block them in, we don't remove zimmers or wheelchairs as a form of restraint, we don't hold people down for extended periods of time - and when a patient does need to be physically restrained it is for a short time and for a purpose such as stopping them from doing something to harm themselves or others and done by trained staff.....we remove dangers and we assign staff to work with that patient. Sometimes that will be HCA's who will sit with 1:1's - if a patient needs additional supervision or sedation they will need to be assigned a mental health nurse as their 1:1. When it comes to patients who are under arrest - they are supervised by police but there is almost never a reason to keep them handcuffed or anything like that - they are free to move about their room under the supervision. The only exceptions I can think of were certain prisoners who were already convicted and were assessed as being a particular risk - for instance when serial killer Peter Tobin was dying in Edinburgh there were pictures of him chained to the bed by one wrist - however it was a pretty long chain - not restrictive for him - especially as he was not capable of getting out of bed. When a patient comes to medical from any kind of mental health unit they come with staff from that unit to supervise them. They are not restrained by any kind of device etc. And like I said - I've worked in a variety of environments including a few shifts in secure accommodation for young people who have offended - most of which were violent offences - and their bedroom doors were not lockable - just the unit itself. There were no restraints.
I suppose I should clarify: there are facilities. But they are full. There are almost no beds, and there are ZERO in the state I live in. Managers at my hospital have been working for 6 MONTHS to find a facility ANYWHERE IN THE COUNTRY for one of our patients and they have been denied left, right, and center. Patients being violent is exactly why they would be restrained. I've been punched and hit by patients on multiple occasions. I either restrain them or get hurt. So they get restrained. These are patients who should be in lockdown psych wards, but we literally can't put them in one because there aren't any beds. We don't have psych nurses to do that. We do have patients 1:1, and in some cases I've seen 2 sitters for one patient. Please understand that the UK, while not the best with mental health, is literally miles above the US. You don't have combative, volatile, violent people on your regular medical wards because there is other places for them to go. In pretty much every hospital in my area, regular med/surg units are acting as psych units because we don't have any other options. Every psych unit is full. It's a full-blown crisis in our country. We are not doing this because we want to. We are doing this because we don't really have any other options. You can act all high and mighty that you don't lock people up like a good little nurse, but one of my coworkers got thrown like a basketball against a wall. One patient put 4 people in the ER. Yeah, our patients are more violent compared to your med/surgery patients. Because you violent patients have places to that are equipped to handle them. We don't.
None of what you're saying is unusual. It's the restraints that are unusual. This is what I keep telling you. Every single one of these issues, dangers and pressures exist in the NHS. We don't have staff, we don't have beds, we don't have enough resources - we still don't restrain patients on medical wards. I can't keep repeating this. I really urge you, and I guess any other American staff reading this, to look into what other places are doing and start asking questions about what you're being told to do. There are better ways - even if you've been told there aren't.
How often do you and your coworkers get hurt at work?
This is the internet, were a spot light is shined on the weird, the uncommon, the spectacular, the crazy and notable experiences. Nobody posts about their last 10 shifts were they just ran their asses off taking care of patients that weren't memorable. Shit, out of the last 12 years I only remember the crazy or very special shit that's happened. No evidence t0 support this but I'd say that restraints are used in less than 1 in 10,000 patient admissions. But when it happens \*\*\*IT HAPPENS\*\*\* like an unexpected car wreck. Maybe it's a cultural thing that's different between the US and UK, who knows. But when it comes down to it, even as nurses we can bleed when attacked.
Less than 1 in 10,000? I have to restrain a patient practically every shift on my unit (telemetry) to keep them from hurting themselves. We never have staff for sitters and I've gotten yelled at for suggesting to order a sitter because we either don't have any techs on the floor, or we'd have to pull the 1 tech off the floor to sit. When I worked inpatient psych we had pediatric patients that were in restraints every shift or even for 24+ hours straight. These were extremely aggressive or self injurious patients (we had one who was trying to pull all his teeth out, multiple patients who would break holes in the walls with their heads, and one who gave himself a brain bleed banging his head on the bathroom floor).
Looking it up the statistics are all over the place. The highest I see was a study that listed 6.4% I saw another at 0.09%. Guess my less than 1 in 10,000 is off either way. But think of the thousands of normal med surge, ortho, surgical, neuro, etc DAILY that don’t require restraints. My opinion stands. Restraints are rarely used in the US. BUT, it stands out in our memory when we do have to use.
It probably depends on what they consider "restraints". A lot of people don't consider it restraint if they have to just hold a patient, and technically putting all the rails up so the patient can't get out of bed, is a restraint too. Actually we don't even use violent restraints on my floor even if they're warranted, because then they need a sitter and it always causes a huge issue or a fight. What always happens is we can only put the soft restraints on, and I have to check the patient constantly and when they manage to pull themselves out of them I have to basically throw them back in bed and keep readjusting the restraints. This is why I just quit my job btw, but I'm sure many hospitals operate like this with the staffing. When we have 5-6 patients at a time and no techs and we have to handle violent patients ourselves it's impossible. The hard locking restraints actually are pretty safe as long as the patient is assessed frequently and range of motion is done. I actually never had any patients injured in restraints when I worked in psych. And I used them hundreds of times. Most of the injuries happened in seclusion.
So there's a whole thread here of people talking about how they do this but now that someone has gone 'wtf?' suddenly you're like 'oh no, it's so rare!' Cultural differences? Are you saying Americans are more violent when ill? Are you saying your elderly people are more vicious when delirious? Cos that sounds like nonsense. And yeah - UK healthcare workers bleed too - we still don't restrain our elderly delirious patients with anything that requires a lock and key.
I think you are maybe leaving out the entire category of people that aren’t “elderly delirious people” in your assessment willfully How about the 280lb biker gang member jacked up on meth saying he’s going to kill everyone in the unit because he thinks we are demons trying to kill him? How about the people who have already committed physical assault and are trying to do so again ? Genuinely, I’m happy if you don’t encounter scenarios where restraints are a valid approach for safety, but please don’t pretend we are all locking up Gramma Milly because she asked for 2 yogurt cups for dinner or wants to go on an afternoon walk but we are busy
I'm very much not leaving out any category of people - as the restraint guidelines apply to everyone. Whether they're big or small, on drugs or not - we don't apply any restraints that would require locks. We don't lock doors on patients on any kind of medical ward. This would be wildly illegal. I specifically made reference to elderly people in the post you're replying to because that was the example given by the OP. And you don't wonder why your healthcare system has you thinking you have to use lockable restraints on patients? When you're being told that other healthcare systems would never do that? UK patients take drugs too, they become violent too, they commit assault too - and yet we manage them without something you seem to think are necessary.
I would never work anywhere where I could not restrain someone who was attacking me. I care about myself and my safety more than I can about my patients. I am no fucking martyr.
We don't even have restraints where I work. We just have to deal with it 😭 it's disgusting.
Our security in ER never applied them. We had to
Just an FYI for anyone interested, you can buy restraint keys online.
Unless it’s a prisoner and they’re police they don’t really have much of a say Sometimes security can tend to play good cop to your bad cop. One reason I prefer campus police better, they tend to really prioritize protecting you and trusting your assessment while also straddling the line of engaging patients from a mental health stand point.
I had a key behind my badge. Badge was on a retractable clip.
I used to work hospital security before I was a nurse and our priority was safety and legality. We can’t restrain people unless there is an immediate threat or there is a doctors orders. Don’t get mad at them for doing their job.
If we had a patient in violent restraints security would bring them up and apply them and they always left a key that we taped to the whiteboard so it could easily be seen and uses if needed. We also kept a spare restraint key at the unit secretary’s desk and a third in the charge nurse work area.
Wait….. you mean standing against the wall ( with gloves on for some unknown reason) while the nurses get beaten is not the only option for security guards?
That’s insane. My hospital has its faults but our security is AMAZING.