Recently, I was met with a very angry family member. “Why is my brother tied to the bed?” He asked. “I’m usually a very reasonable man but he cannot speak for himself. So I sure will. And I’m very upset about this!” were his next words.
Surely, I should have been offended. After all, I just saved his life. You’re welcome.
But the realities of restraints in the hospital setting are heart breaking. And usually occur in the most fragile of patients – the critically ill and the cognitively impaired. So, how does one decide when it is ok to tie a patient’s wrists to the bedrails? And how often does this occur? What are the patient’s thoughts on this practice? And why is this practice even allowed by the hospital governing bodies?
I will tell you this. I know, that as a hospitalist physician, I get those calls. You know the one. “Doc, Mr X has removed his IV access and is streaking naked down the hall screaming ‘They’re not gonna getting me.” And I will have to respond to that escalating situation with an overhead announcement of “Code Manpower Needed.”
And I also know that I will get the call that little Ms. Y is hosing down her toes with her running IV antibiotics while planting new flowers in the brown soil of her diapers.
And that Little Jonny, physically all grown up, is still mentally challenged and giving the staff a hard time by not staying put.
Or that Joey Shmoey has extubated himself and is now a pale shade of grey.
So what do we do?
Now of course, you should be rightfully up in arms! Repeat after me… “What? That’s your answer? Aren’t there other modalities that can be attempted prior to resorting to HANDCUFFS? exclamation! Exclamation! EXXCLAMMATIONS !!!!
And the answer is … yes of course. Who do you think we are? savages? Wait. don’t answer that. But serious, “not staying-put” is not a valid reason for restraints. So keep reading.
The PSQH website on Patient Safety and Quality Healthcare recently published an article on just this public concern. They entitled it “The Correct Use of Physical Restraints in the Inpatient Setting”, a titles that begs one to wonder of the incorrect uses. And they have pointed out that it is a slippery slope.
So when my angry family member voiced his advocating rights, I have no choice but to nodded and validated. And when alternative therapeutic modalities were suggested, I considered them and offered a few of my own. Until we all come to a consensus. In this case, given this situation, at this current time, in this current state, restraints was the safest modality to offer 1st line treatment.
The truth is, however, that the optics of restraints aren’t easily reconciled with its necessity. Nor are its adverse effects.
So although this case resulted in a mutual agreement, the next case may be you or your family. Or maybe it’s me. On a slippery slope.
So what do you do? You ask questions. You say something. You advocate. You wait for the rational. And you help to make the treatment process safe and effective.
What can you do? You can stay at bedside. Because we will respect your wishes to remove restraints while patient is under your supervision.
What are your views? I’d like to hear from you.
*Featured hand photo taken from free photo library