chemical restraints

[brodaiga]

Do you ever help out the nurses/techs to hold down the pt if a chemical restraint is needed or do you have a hands off approach? I am hands off, but felt bad yesterday when the techs/nurse were women and I stood back. Thoughts?

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[notdeadyet]

Do you ever help out the nurses/techs to hold down the pt if a chemical restraint is needed or do you have a hands off approach? I am hands off, but felt bad yesterday when the techs/nurse were women and I stood back. Thoughts?

It varies by institution. I work at a psychiatric ER where it's appreciated when docs lend a hand. I've worked at others where it's appreciated that you DON'T. Places have different protocols for doing takedowns or chemical restraints and if you don't have the same training as the folks you're working with, it can cause problems.

I tend NOT to be hands-on with any kind of restraints in a typical inpatient environment (meaning one in which I'm going to see a patient for a few days). While some patients have no idea what's going on by the time they require that level of intervention, some will remember and you can really kill a therapeutic alliance.

 

[Shikima]

If chem restraints are needed, it's due to safety and/or psychosis reasons. I've always lent a hand in order to break the cycle than allow potentially violent instances happen. Again, I've always had good relationships with departmental PD who've assisted and was always up front in what's going on with the Pt prior to initiation.

 

[heyjack70]

I would provide hands on support only when absolutely necessary (eg if a patient was attacking someone and I was the only one there to intervene). Otherwise the ED and RN staff usually have regular training and more experience utilizing that training. If I was trained and in an environmen where I had minimal continuity (like the ED) I would be more likely to assist with hands-on because I won't be relying as much on the therapeutic relationship with the patient.

 

[Shikima]

I would provide hands on support only when absolutely necessary (eg if a patient was attacking someone and I was the only one there to intervene). Otherwise the ED and RN staff usually have regular training and more experience utilizing that training. If I was trained and in an environmen where I had minimal continuity (like the ED) I would be more likely to assist with hands-on because I won't be relying as much on the therapeutic relationship with the patient.

Get as much training as you can. Never know what will happen when you are eventually on your own and could be alone in your clinic.

 

[shan564]

Don't you guys have security for this purpose?

 

[Shikima]

Don't you guys have security for this purpose?

Not all clinics and hospital systems will have security. Cannot depend upon this - too easy to become complacent in the training environment because you have access to many different options and specialties and this can develop institutionalization.

 

[whopper]

I don't like giving out Geodon IM, but where I'm at, the nurses all want it done first.

Reason why I don't like Geodon IM is the several blackbox warnings and contraindications with mixing it with other meds like Thorazine. I describe it as the one bullet gun. If you go into a fight, you shoot and miss, you want more bullets in there just in case. You shoot with Geodon and it doesn't calm the patient down, with all the warnings against mixing it with other meds, it makes you really hesitant to want to give something that will almost likely knock the patient out like Thorazine.

It's possible several of those contraindications are bogus given that the QT stuff that came out when Geodon was still new turned out to be overblown but nonetheless they're still on the package.

When injecting patients due to an emergency always be on hand and easy to access for the staff members. You hesitate or get slow in responding to their requests for an IM, you could literally end up being the reason why one of them gets punched in the face and ends up with permanent chronic headaches for the rest of their life.

Such things are a type of situation where just a few seconds of hesitation could've prevented a severe assault on staff members and patients.

 

[vistaril]

Do you ever help out the nurses/techs to hold down the pt if a chemical restraint is needed or do you have a hands off approach? I am hands off, but felt bad yesterday when the techs/nurse were women and I stood back. Thoughts?

hands on(for chemical and physical restraints) if I'm on the unit.

 

[Ibid]

Prepare for violence and you will create the conditions in which violence will thrive.....

 

[TexasPhysician]

If working as a contractor at a facility, participating could have legal consequences.

 

[Lauraaa]

At our institution on (an inpatient ward) the nurses certainly appreciate if the physicians help during behavioral codes requiring restraints, and I also think some resent the fact that while all of us are supposedly "trained" for acting with aggressive patients, that the culture is usually that the doctors are usually the ones who write the orders for meds and restraints or seclusion and then step back and allow the nursing staff to physically handle the patients. I am expecting a little one at the current time, so I made a decision that I will not involve myself in physical altercations unless for exceptional circumstances where noone else is present. If there are already several people working with the agitated patient, then I will do others needed actions, like of course write the orders for meds / restaints, getting extra restraints, or calming the others patients, moving them back into their rooms out of the immediate area, etc. But if I was not pregnant, and if I am not the person that the patient is targeting at the moment, then I would assist if I could help. If I am the person targeted and being focused on by the patient, then I usually step out of the vicinity since assisting could very well make the person more agitated.